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At least 631 records · Page 35Linked to original sources
PubMed2006

A psychometric evaluation of the DSM-IV pathological gambling diagnostic criteria.

Specific diagnostic criteria for pathological gambling (PG) have been available for 25 years, since the publication of DSM-III. Little research has examined the psychometric performance of the diagnostic criteria. The goal of the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project was to examine the sensitivity, specificity and predictive values of the DSM-IV PG criteria for psychiatric outpatients who screened positive for a gambling problem. A total of 1709 psychiatric outpatients were evaluated with a semistructured diagnostic interview for PG. Of all patients 88 screened positive for PG, 40 of whom met DSM-IV diagnostic criteria for a lifetime history of PG. All ten DSM-IV criteria were significantly more frequent in the PG group. The sensitivity of the criteria ranged from 25.0% to 90.0% (mean = 67.8%), whereas specificity ranged from 62.5% to 100% (mean = 81.9%). Positive predictive values ranged from 64.1% to 100% (mean = 78.9%), and negative predictive values ranged from 61.5% to 90.7% (mean = 77.1%). Guidelines are recommended for determining whether a diagnostic criterion should be retained as part of the set of diagnostic criteria, and our results suggested that two of the DSM-IV PG criteria are candidates for elimination (criterion 8--commitment of illegal acts; criterion 10--reliance on others for financial assistance to relieve a desperate financial problem).

Adult↗
PubMed2006

Evaluation of 10 commercial diagnostic kits for in vitro expressed hepatitis B virus (HBV) surface antigens encoded by HBV of genotypes A to H.

Genetic variability of the hepatitis B virus (HBV) constitutes one of the major challenges for diagnosis of HBV infection. It is plausible that amino acid substitutions in the "a" determinant of the HBV surface antigen (HBsAg) that affect antigenic sites, whether originating from genetic diversity or from mutations in the HBV strain itself, will affect the sensitivity of some diagnostic kits. In fact, recent studies have indicated that some diagnostic kits had false negative results with particular HBsAg mutants. There have been, however, few substantial studies evaluating sensitivities of diagnostic kits to the HBsAg encoded by different HBV genotypes. Our recent study found that 10 diagnostic kits available in Japan were able to detect HBsAg irrespective of whether it originated from HBV genotypes A, B or C, with the latter two genotypes being the dominant species in East Asia. In this study, we extended our previous efforts by assessing the ability of diagnostic kits to detect recombinant HBsAg derived from HBV genotypes A to H. Our results demonstrated that 9 out of 10 diagnostic kits evaluated were able to detect as low as 0.2 International Units (IU)/ml HBsAg, irrespective of HBV genotype. The genotypic differences in the HBV family thus appear to have little impact on the sensitivity of currently available HBsAg diagnostic kits.

Cell Line↗
PubMed2000

Diagnostic errors in three medical eras: a necropsy study.

BACKGROUND: Studies comparing the accuracy of clinical diagnosis in unselected patients who died in hospital in different medical eras have shown no decline of errors in the main diagnosis. We assessed changes in diagnostic accuracy over 20 years. METHODS: We analysed retrospectively diagnostic errors, with use of necropsy as the gold standard for diagnosis. We randomly selected 300 patients who died at a tertiary-care teaching hospital in Switzerland--100 in each of 1972, 1982, and 1992. We classified discrepancies between clinical diagnosis and necropsy findings as major and minor errors. FINDINGS: The overall necropsy rate at the hospital stayed at around 90% for the whole period. During the study, the frequency of major discrepancies declined significantly (1972, 30%; 1982, 18%; 1992, 14%; p=0.007). The rate of minor diagnostic errors increased significantly from 23% in 1972 to 46% in 1992 (p<0.001). The increase in overall diagnostic accuracy occurred mainly because of a significant improvement in specificity for cardiovascular diseases (1972, 85%; 1982, 82%; 1992, 97%; p=0.034) and non-significantly improved sensitivity (1972, 69%; 1982, 82%; 1992, 86%; p=0.061). Sensitivity also improved for infectious diseases (1972, 25%; 1982, 67%; 1992, 86%; p=0.036). Sensitivity and specificity for neoplastic diseases were high originally and did not change. The total number of diagnostic procedures per year increased from 191 in 1972 to 259 in 1992, mainly because of non-invasive techniques, such as ultrasonography, and endoscopies. INTERPRETATION: The frequency of major diagnostic errors in unselected patients who died in hospital was halved over 20 years, probably because of improved clinical skills and new diagnostic procedures.

Aged↗
PubMed2003

[Duration of the diagnostic process for lung cancer versus other solid tumors at the National Oncology Institute of Ecuador].

OBJECTIVE: To determine the duration of the outpatient diagnostic process for lung cancer in comparison to that of other solid organ tumors/all tumors at the National Oncology Institute-Society to Fight Cancer (ION-SOLCA) of Ecuador. PATIENTS AND METHODS: All patients with non-small cell lung cancer (NSCLC) seen between January 1 and December 31, 1995 at the ION-SOLCA, a specialized tertiary care hospital in Guayaquil, Ecuador, were studied. The duration of the patients' diagnostic process was compared to that of other patients with solid organ tumors (1 control per NSCLC patient). DESIGN: Retrospective study of health care services to measure the duration of each stage of the diagnostic process for cancer patients at the ION-SOLCA. MEASURES: The main variable was the duration of the diagnostic process. The duration of each phase of the process was also recorded. RESULTS: Results are given as means ( standard deviations, with standard errors between parentheses). The overall duration of the diagnostic process for all solid organ tumors (lung and others) at the ION-SOLCA was 54.5 days 62.3 (7.6). No differences were detected between the duration of diagnosis for lung and other tumors. The durations of the different phases of diagnosis were as follows: from the first pre-admission contact with the hospital until a visit with a specialist, 12.5 days 11.4 (1.4); from the visit with a specialist until a diagnostic procedure, 33.3 days 57 (7); and from the diagnostic procedure until the pathological diagnosis, 8.7 days 6.9 (0.8). CONCLUSIONS: Outpatient evaluation is an inefficient, slow and potentially dangerous process in cases in which the probability of a cancer diagnosis is high. A more interventionist process involving hospital admission may accelerate diagnosis in such cases.

Cancer Care Facilities↗
PubMed2003

Systematic reviews with individual patient data meta-analysis to evaluate diagnostic tests.

Systematic literature reviews with meta-analysis of reported data in diagnostic research studies about the accuracy of tests assist clinicians in decision-making. However, there are limitations to this approach as the analysis of such data often does not allow reviewers to explore the diagnostic information gained from combinations of tests. In recent years meta-analysis of individual patient data (IPD) has been introduced as gold standard analytic approach in systematic reviews of randomised controlled trials. Application of IPD meta-analysis in systematic reviews of diagnostic tests can allow advanced analysis to decipher the real value of testing. In particular, the additional information provided by testing can be examined in light of the information already known from history and examination. To our knowledge there are no IPD meta-analyses in diagnostic research so far. This commentary aims to highlight the benefits of IPD meta-analysis in the diagnostic domain and demonstrates how strategies for diagnostic work-up of women with postmenopausal bleeding could be improved using this approach in systematic reviews of diagnostic research on accuracy of ultrasound and hysteroscopy.

Diagnostic Tests, Routine↗
PubMed2003

Diagnostic research on routine care data: prospects and problems.

A diagnosis in practice is a sequential process starting with a patient with a particular set of signs and symptoms. To serve practice, diagnostic research should aim to quantify the added value of a test to clinical information that is commonly available before the test will be applied. Routine care databases commonly include all documented patient information, and therefore seem to be suitable to quantify a tests' added value to prior information. It is well known, however, that retrospective use of routine care data in diagnostic research may cause various methodologic problems. But, given the increased attention of electronic patient records including data from routine patient care, we believe it is time to reconsider these problems. We discuss four problems related to routine care databases. First, most databases do not label patients by their symptoms or signs but by their final diagnosis. Second, in routine care the diagnostic workup of a patient is by definition determined by previous diagnostic (test) results. Therefore, routinely documented data are subject to so-called workup bias. Third, in practice, the reference test is always interpreted with knowledge of the preceding test information, such that in scientific studies using routine data the diagnostic value of a test under evaluation is commonly overestimated. Fourth, routinely documented databases are likely to suffer from missing data. Per problem we discuss methods that are presently available and may (partly) overcome each problem. All this could contribute to more frequent and appropriate use of routine care data in diagnostic research. The discussed methods to overcome the above problems may well be similarly useful to prospective diagnostic studies.

Bias↗
PubMed2003

Toward complete and accurate reporting of studies of diagnostic accuracy: the STARD initiative.

RATIONALE AND OBJECTIVES: To comprehend the results of diagnostic accuracy studies, readers must understand the design, conduct, and analysis of such studies. The authors sought to develop guidelines for improving the accuracy and completeness of reporting of studies of diagnostic accuracy in order to allow readers better to assess the validity and generalizability of study results. MATERIALS AND METHODS: The Standards for Reporting of Diagnostic Accuracy group steering committee searched the literature to identify publications on the appropriate conduct and reporting of diagnostic studies and to extract potential guidelines for authors and editors. An extensive list of items was prepared. Members of the steering committee then met for 2 days with other researchers, editors, methodologists, statisticians, and members of professional organizations to develop a checklist and a prototypical flowchart to guide authors and editors of studies of diagnostic accuracy. RESULTS: The search for published guidelines on diagnostic research yielded 33 previously published checklists, from which the group produced an initial list of 75 items. This list was honed to 25 key items by group consensus and on the basis of published research on bias. A prototypical flowchart was developed as a tool for conveying information about the method of patient recruitment, the order of test execution, and the numbers of patients undergoing the test under evaluation, the reference test, or both. Potential users reviewed the conference version of the checklist and flowchart and provided additional suggestions, which were then incorporated. CONCLUSION: Use of these carefully developed, consensus-based guidelines should enable clearer and more complete reporting of studies of diagnostic accuracy, as well as better reader understanding of the validity and generalizability of study results.

Bias↗
PubMed1994

An index for diagnostic accuracy in the multiple disease setting.

RATIONALE AND OBJECTIVES: Evaluation of diagnostic accuracy in the clinical environment should entail some assessment of performance in patients with multiple abnormalities. Although receiver operating characteristic (ROC) curves often are used to assess the diagnostic accuracy of imaging systems, the concept is not easily generalizable to patients with multiple abnormalities. I propose a measure of diagnostic accuracy that is a generalization of the area under the ROC curve for a single disease. METHODS: The proposed measure of diagnostic accuracy is a weighted average of the area under individual ROC curves for the single disease setting and of components representing areas under ROC curves constructed for patients with multiple diseases. Several options are discussed for scoring the presence of abnormality for patients who have two or more abnormalities. RESULTS: Methods of estimating diagnostic accuracy are demonstrated on a set of data in which more than one third of the abnormal cases included multiple abnormalities of chest disease. CONCLUSION: An easy-to-use method is given to estimate diagnostic accuracy in the multiple abnormality setting. This should make it easier to incorporate cases with multiple abnormalities when assessing the diagnostic accuracy of imaging systems.

Diagnosis, Differential↗
PubMed1998

Quantitative information of specific diagnostic tests.

The goal of diagnostic testing is to maximize information (I) of a specific disease of interest (D) resulting from the performance of a specific diagnostic test procedure (T). However, all tests suffer from errors which result in incomplete information and inaccurate diagnostic conclusions. The methods of Information Theory have successfully solved a range of signal transmission problems involving physical systems operating under conditions of noise. Medical testing procedures were found to be analogous to noisy systems; hence, Information Theory methods were applied to minimize errors in diagnostic testing. Prior to performing a diagnostic test, the quantity of information, Apriori Information (ID), regarding the presence or absence of the disease was only a function of the prevalence (P) of disease in the population. After performing a diagnostic test, the quantity of information, Aposteriori Information (IDIT) was a function of not only P but also the test sensitivity (A) and test specificity (B). The quantity of information gained by test performance was computed from the difference between aposteriori and apriori information. delta I = IDIT - ID To illustrate the relationship between pretest, apriori, and post-test, aposteriori, information the values of ID and IDIT were computed for five common cardiovascular tests applied to populations with different coronary artery disease prevalence. This cross-sectional analysis studied the quantitative information obtained from Electrocardiography (ECG), Bicycle Ergometer Stress Tests (BEST), Stress-Echo Ergometer Tests (SEET), Thallium 201 Stress Tests (ThST), and Coronary Arteriography (CorA). Apriori information ranged from a minimum of 0 (for prevalence = 0.5) to a maximum of 1.0 (for prevalence = 0 or 1.0) The aposteriori information was computed for all apriori information and occupied the range between that of a "perfect" test (A = 1.0 and B = 1.0) and that of a "worthless" test (A = 0.5 and B = 0.5). All tests demonstrated greater information gain when apriori information was minimal; Little additional information could be gained when the apriori information was close to certainty (i.e., for prevalence near 0 or 1.0). Electrocardiography demonstrated little significant IDIT at any value of ID. Thallium 201 stress tests provided similar aposteriori information values to those of Stress-Echo Ergometer Stress and either demonstrated greater information gain than Bicycle Ergometer Stress Tests. Coronary Arteriography provided the maximum values of aposteriori information. Information Theory methods provided an effective quantitative method to compare the effectiveness of diagnostic tests over a wide range of disease prevalence.

Adult↗
PubMed1997

Diagnostic yield of brain biopsy in neurodegenerative disorders.

OBJECTIVE: The diagnostic yield and therapeutic implications of brain biopsy were determined in a series of 50 consecutive brain biopsies that were performed in 48 patients between 1990 and 1995 at The Johns Hopkins Hospital to assess progressive neurodegenerative disorders of unclear origin. METHODS: Severely immunocompromised patients and patients undergoing biopsies for suspected neoplastic lesions were excluded from this analysis. Before surgery, the patients had undergone extensive laboratory and radiographic tests, including lumbar puncture (all 48 patients), electroencephalography (26 of 48 patients), magnetic resonance imaging (all 48 patients), and angiography (17 of 48 patients). Despite the results of these studies, diagnoses could not be established, and thus, brain biopsies were undertaken. RESULTS: Only 10 of the 50 biopsies (44 open procedures and 6 stereotactic procedures) led to diagnoses, resulting in a diagnostic yield of 20%. An additional three biopsies (6%) were only suggestive of diagnoses. The results of 33 biopsies (66%) were abnormal but nonspecific, and the results of 4 (8%) were normal. Minor complications associated with biopsy occurred in five cases (10%), and there were no deaths. Of the 10 patients whose biopsies were diagnostic, only 4 underwent meaningful therapeutic intervention as a result of the procedure, resulting in an overall therapeutic benefit in only 8% of all the cases. An analysis of patient subgroups to elucidate a correlation with diagnostic biopsy revealed that patients with focal magnetic resonance imaging findings had the highest likelihood of a diagnostic biopsy (odds ratio, 4.00). Electroencephalography and laboratory abnormalities were not predictive of a diagnostic biopsy. CONCLUSION: We conclude that the current diagnostic yield (20%) of brain biopsy for progressive neurodegenerative disorders is lower than that of earlier reports and that the therapeutic benefits of the procedure are limited.

Adolescent↗
PubMedDate not supplied

Noninvasive diagnostic testing of coronary artery disease in women.

Noninvasive diagnostic testing of coronary artery disease (CAD) is widely recognized as an area that is less studied and less accurate with regard to women than to men. Accurate and safe diagnostic testing constitutes the crucial link between early detection and optimal management of CAD. Many noninvasive diagnostic modalities are available to the clinician, including traditional electrocardiography, the relatively novel imaging of echocardiography, the emerging nuclear perfusion technology of electron beam computed tomography, exercise testing, and pharmacologic testing. The most accurate and cost-effective diagnostic method for patients depends on the patients' pretest likelihood of the disease as determined by factors such as sex, age, and cardiovascular risk factors. Noninvasive tests are most useful in the diagnosis of CAD in patients with intermediate pretest likelihood of CAD. Patients with low pretest likelihood of CAD with normal electrocardiograms may benefit from noninvasive tests or a watchful waiting strategy. Patients with a high pretest likelihood of CAD may benefit greatly from direct referral to coronary angiography. Among the noninvasive diagnostic methods, exercise electrocardiography is the most studied and least accurate with regard to women patients. Electrocardiography improves in accuracy when combined with imaging techniques such as echocardiography or nuclear single photon emission computed tomography. Combining data from all studies has shown that exercise echocardiography yields the highest diagnostic accuracy in women among all of the exercise stress tests. Patients who are unable to achieve maximal exercise capacity may undergo pharmacologic testing using dipyridamole or adenosine radionuclide perfusion or dobutamine echocardiography. Recent development of electron beam computed tomography accurately detects coronary artery calcium but has not been validated yet as a standard diagnostic test for CAD.

Coronary Angiography↗
PubMed1997

Diagnostic strategies for the management of patients with clinically suspected deep-vein thrombosis.

Given the perceived inaccuracy of clinical diagnosis, patients with suspected deep vein thrombosis should have objective testing. Due to the inherent limitations of the reference method (contrast venography), several diagnostic strategies using noninvasive tests have been developed. These strategies share two components: anticoagulant therapy is initiated only in patients with an abnormal test, and serial testing is performed in patients with an initial normal test result. A thorough search of the literature was done to identify all studies that have evaluated the feasibility, accuracy, and safety of diagnostic strategies in patients with clinically suspected deep vein thrombosis. The safety of the individual diagnostic strategies was expressed as the total rate of venous thromboembolic complications. Feasibility was expressed as the mean number per patient of extra visits to the hospital and additional tests per patient. A total of 12 reports qualified for the analysis. The diagnostic strategies included venography, serial impedance plethysmography with and without 125I-fibrinogen leg scanning, serial ultrasound imaging with and without D-dimer determination, serial ultrasound imaging in combination with a clinical score, and a diagnostic work-up including ultrasound imaging, impedance plethysmography, D-dimer determination, and a clinical score. The observed venous thromboembolic complication rates varied between 0.4% and 2.6%. Feasibility was lowest for the initial serial impedance plethysmography strategy (mean number of extra hospital visits and mean number of additional tests, 4.1 per patient). Strategies that used the D-dimer test complimentary to ultrasound imaging or the combination of impedance plethysmography and a clinical score performed best (mean number of extra hospital visits and mean number of additional tests, approximately 0.3 per patient). All available noninvasive diagnostic strategies are as accurate and safe as contrast venography for the treatment of patients with clinically suspected deep vein thrombosis. The recently introduced simplified diagnostic strategies allow treatment decisions to be made on the day of presentation in most patients.

Anticoagulants↗
PubMed2006

Diagnostic yield in the clinical genetic evaluation of autism spectrum disorders.

PURPOSE: Clinical geneticists are often asked to evaluate patients with autism spectrum disorders (ASDs) in reference to questions about cause and recurrence risk. Recent advances in diagnostic testing technology have greatly increased the options available to them. It is not currently clear what the overall diagnostic yield of a battery of tests, either collectively or individually, might be. The purpose of this study was to evaluate the diagnostic yield of a stepwise approach we have implemented in our clinics. METHODS: We used a three-tiered neurogenetic evaluation scheme designed to determine the cause of ASDs in patients referred for clinical genetic consultation. We reviewed the results of our diagnostic evaluations on all patients referred with a confirmed diagnosis of autism over a 3-year period. RESULTS: By using this approach, we found an overall diagnostic yield for ASDs of more than 40%. This represents a significant increase in the diagnostic yield reported just a few years ago. CONCLUSIONS: Given the implications of these diagnoses on recurrence risk and associated medical conditions, a targeted neurogenetic evaluation of all persons with ASDs seems warranted. We discuss the issues in the future implementation of a fourth tier to the evaluation with the potential for an even higher diagnostic yield.

Autistic Disorder↗
PubMed2006

Comparison of different clinical diagnostic criteria for depression in Alzheimer disease.

OBJECTIVE: Data in the literature show different estimates of the prevalence of depression in patients with Alzheimer disease (AD) when different classification systems are used. This study describes the prevalence and clinical features of depression in AD based on five different depression classification systems. METHODS: This was a cross-sectional, observational study of 491 patients with probable AD. Depression was diagnosed using five classification systems (International Classification of Diseases, 10th Revision [ICD-10], Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition [DSM-IV], Cambridge Examination for Mental Disorder of the Elderly [CAMDEX], Provisional Diagnostic Criteria for depression in AD [PDC-dAD], Neuropsychiatric Inventory [NPI]). RESULTS: The prevalence of depression was 4.9% (95% confidence interval [CI]: 3.2-7.1) according to ICD-10 criteria; 9.8% (95% CI: 7.3-12.6) according to CAMDEX; 13.4% (95% CI: 10.6-16.6) according to DSM-IV; 27.4% (95% CI: 23.6-31.5) according to PDC-dAD criteria; and 43.7% (95% CI: 39.4-48.2) when using the screening questions from the NPI depression subscale. The level of agreement between the classification systems was low to moderate (kappa <0.52). The characteristics associated with the most diagnostic disagreement were loss of confidence or self-esteem and irritability. CONCLUSIONS: This study shows that there is a high variability in the prevalence rates of depression in AD depending on the diagnostic criteria used and that there is a low rate of agreement among the diagnostic criteria analyzed. The results suggest that the use of generic diagnostic criteria such as the ICD-10, the CAMDEX, or DSM-IV provides low prevalence rates of depression in patients with AD compared with specific diagnostic criteria such as the PDC-dAD.

Aged↗
PubMed2005

From complexity to category: responding to diagnostic uncertainties of autistic spectrum disorders.

OBJECTIVE: Recent data from Education Queensland has identified rising numbers of children receiving diagnoses of autistic spectrum disorder (ASD). Faced with funding diagnostic pressures, in clinical situations that are complex and inherently uncertain, it is possible that specialists err on the side of a positive diagnosis. This study examines the extent to which possible overinclusion of ASD diagnosis may exist in the presence of uncertainty and factors potentially related to this practice in Queensland. METHODS: Using anonymous self-report, all Queensland child psychiatrists and paediatricians who see paediatric patients with development/behavioural problems were surveyed and asked whether they had ever specified an ASD diagnosis in the presence of diagnostic uncertainty. Using logistic regression, elicited responses to the diagnostic uncertainty questions were related to other clinical- and practice-related characteristics. RESULTS: Overall, 58% of surveyed psychiatrists and paediatricians indicated that, in the face of diagnostic uncertainty, they had erred on the side of providing an ASD diagnosis for educational ascertainment and 36% of clinicians had provided an autism diagnosis for Carer's Allowance when Centrelink diagnostic specifications had not been met. CONCLUSION: In the absence of definitive biological markers, ASD remains a behavioural diagnosis that is often complex and uncertain. In response to systems that demand a categorical diagnostic response, specialists are providing ASD diagnoses, even when uncertain. The motivation for this practice appears to be a clinical risk/benefit analysis of what will achieve the best outcomes for children. It is likely that these practices will continue unless systems change eligibility to funding based on functional impairment rather than medical diagnostic categories.

Autistic Disorder↗
PubMed2005

The challenge of diagnosing pulmonary embolism in elderly patients: influence of age on commonly used diagnostic tests and strategies.

Pulmonary embolism (PE) is a potentially fatal disease if left untreated. The prevalence of PE increases markedly with age, and its diagnosis in elderly people is difficult because many cardiopulmonary conditions may mimic clinical presentation of PE, and age may unfavorably influence the characteristics of diagnostic tests for PE. The modern approach to PE is based on sequential diagnostic strategies based on clinical probability, D-dimer measurement, lower limb compression ultrasonography, ventilation-perfusion lung scan, and helical computed tomography (hCT). Pulmonary angiogram is rarely necessary because the noninvasive diagnostic evaluation is usually conclusive. Age reduces the clinical usefulness of D-dimer and ventilation-perfusion lung scan. D-dimer allows excluding PE in only 5% of patients aged 80 and older, compared with 60% younger than 40. Similarly, the rate of inconclusive ventilation-perfusion lung scans is almost twice as high (58%) in patients older than 70 and in patients younger than 40 (32%). In contrast, aging does not change the diagnostic accuracy of clinical probability assessment, whether empirical or as determined by prediction rules, nor appear to influence the diagnostic characteristics of lower limb compression ultrasonography and hCT. Therefore, a rational diagnostic approach to PE in older people should rest mainly on the sequential use of those tests that have demonstrated strong diagnostic yield, accuracy, and safety in this population.

Aged↗
PubMed2003

Hemisensory syndrome is associated with a low diagnostic yield and a nearly uniform benign prognosis.

OBJECTIVE: To describe the diagnostic yield and prognosis for patients with hemisensory syndrome. BACKGROUND: The aetiology, utility of diagnostic procedures, and outcome of hemisensory syndrome in patients with exclusive hemibody complaints having only subjective sensory abnormalities on examination is unknown. METHODS: Patients were prospectively identified with hemisensory syndrome in a tertiary care institution from 1998-2002. Diagnostic procedures were analysed for sensitivity and clinical follow up was performed. RESULTS: Thirty four patients, 25 (74%) women, of age 35 (SD 11) years were identified. The hemisensory syndrome occurred on the left side in 23 (68%) cases. Neuroimaging of the brain demonstrated diagnostic abnormalities representing ischaemic aetiology in one case. Other diagnostic testing including cerebrospinal fluid examination, electrophysiological testing, carotid ultrasonography, echocardiography, and blood testing revealed no diagnostic abnormalities. Sixteen patients (47%) continued to complain of hemisensory difficulties after all investigations were completed at 9.6 (5.8) days. One patient with a history of systemic lupus erythematosus and positive antiphospholipid antibodies had a second event diagnosed as stroke seven months after presentation. Clinical follow up at 16 (7) months revealed persisting symptoms in 6 (20%) of 30 patients. Six (50%) of 12 patients agreeing to psychiatric assessment received diagnoses of personality or mood disorders. CONCLUSIONS: Diagnostic yield in hemisensory syndrome is low, and prognosis is almost always uniformly benign. The author advocates careful assessment of medical history and consideration for neuroimaging in this group of patients.

Adult↗
PubMed2005

Cost-effectiveness analysis in the assessment of diagnostic imaging technologies.

In many ways, diagnostic technologies differ from therapeutic medical technologies. Perhaps most important, diagnostic technologies do not generally directly affect long-term patient outcomes. Instead, the results of diagnostic tests can influence the care of patients; in that way, diagnostic tests may affect long-term outcomes. Because of this, the benefits associated with the use of a specific diagnostic technology will depend on the performance characteristics (eg, sensitivity and specificity) of the test, as well as other factors, such as prevalence of disease and effectiveness of available treatments for the disease in question. The fact that diagnostic tests affect short-term, or "surrogate," outcomes, rather than long-term patient outcomes makes evaluation of these tests more complicated than the evaluation of therapeutic technologies. This article will trace the history of technology assessment in medicine, address the role of cost-effectiveness and decision analysis in health technology assessment, and describe unique features and approaches to assessing diagnostic technologies. The article will then conclude with a consideration of the limits of medical technology assessment.

Cost-Benefit Analysis↗