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PubMed2002

Comparative evaluation of the new Sheffield table and the modified joint British societies coronary risk prediction chart against a laboratory based risk score calculation.

BACKGROUND: Management of borderline hypertension and hypercholesterolaemia is based on an individual's coronary heart disease (CHD) risk rather than arbitrary values for blood pressure or serum cholesterol. Prediction of CHD risk involves using tables, charts, or computer programs based on the Framingham equations. The new Sheffield table and modified joint British societies coronary risk prediction (JBS) chart are widely used. The JBS chart approximates age and systolic blood pressure, and the new Sheffield table dichotomises blood pressure, and these simplifications may lead to diagnostic inaccuracy. METHODS: The diagnostic performance of the charts against an individualised laboratory based CHD risk calculation in 1102 subjects in primary care were evaluated and compared. RESULTS: The new Sheffield table and modified JBS chart performed equally well with a respective diagnostic sensitivity and specificity of 91.6% (95% confidence interval 86.7% to 95.1%) and 93.8% (91.1% to 97.9%), and 93.6% (90.4% to 96.0%) and 94.7% (92.6% to 96.1%) at 10 year CHD risk of 15%; and of 95.2% (82.8% to 99.4%) and 97.9% (96.8% to 98.7%), and 90.5% (75.6% to 97.4%) and 100% (99.7% to 100%) at 10 year CHD risk of 30%. The modified JBS chart graphic display provides graded risk, which may be an advantage over the new Sheffield table, which identifies thresholds of risk. The new Sheffield table, unlike any other method, can be used as screening tool for cholesterol measurement. CONCLUSIONS: The new Sheffield table and modified JBS chart are valid for use in primary care since their diagnostic accuracy is unaffected by approximations in age and blood pressure. It is suggested that practitioners should choose whichever risk assessment tool they are comfortable with and use it.

Adult↗
PubMed2006

Prosthesis infection: diagnosis after total joint arthroplasty with antigranulocyte scintigraphy with 99mTc-labeled monoclonal antibodies--a meta-analysis.

PURPOSE: To perform a meta-analysis of diagnostic studies regarding the accuracy of antigranulocyte scintigraphy (AGS) with monoclonal antibodies in the identification of prosthesis infection after total hip or knee arthroplasty. MATERIALS AND METHODS: PubMed and EMBASE searches were conducted for the identification of relevant studies. Data on the diagnostic performance of AGS with monoclonal antibodies were combined quantitatively across eligible studies, and the overall sensitivity and specificity, along with summary receiver operating characteristic (ROC) curves and likelihood ratios (LRs), were estimated. The above parameters were evaluated for all patients and for various subgroups among the eligible studies. The reference standard used in the individual studies was accepted. RESULTS: Thirteen eligible studies on nonoverlapping patient groups were included in the meta-analysis; there was a total sample size of 522 implants. The independent random effects summary estimates of sensitivity and specificity were 83% and 80%, respectively. The summary ROC curve estimate for weighted analysis was a sensitivity of 90% for a specificity of 80%. LR syntheses gave a weighted positive LR of 3.99 (95% confidence interval [CI]: 3.13, 5.09) and a weighted negative LR of 0.22 (95% CI: 0.15, 0.34); there was no statistically significant between-study heterogeneity for either metric. Various subgroup analyses did not reveal any statistically significant differences. CONCLUSION: AGS with monoclonal antibodies had a reasonably high discriminating ability to identify prosthesis infection in patients who underwent total joint arthroplasty.

Antibodies, Monoclonal↗
PubMed2006

Preparation of mycobacteria-containing artificial sputum for TB panel testing and microscopy of sputum smears.

SETTING: Panel testing, blinded cross rechecking and on-site evaluation are the three methods for external quality assessment (EQA) of acid-fast bacilli (AFB) smear microscopy. Panel testing can provide data on laboratory capabilities prior to implementing a rechecking programme, assess the current status of laboratory performance and detect problems associated with diagnostic performance. Thus far, two methods for preparing panel test slides have been reported: these use real AFB-positive and -negative sputum treated with sodium hydroxide (NaOH) or N-acetyl-L-cysteine (NALC). OBJECTIVE: To evaluate the above methods and to develop a new method to prepare panel test slides with artificial sputum. DESIGN: Panel test slides were prepared using the NaOH and NALC methods. New artificial sputum preparation methods were developed and examined using a cultured monocyte cell line, cultured avirulent mycobacteria and methylcellulose or polyacrylamide gel as substrate. Smears prepared by the four methods were compared. RESULTS: Panel test slides prepared with NaOH and NALC methods are not macroscopically or microscopically similar to real smears. Our new artificial sputum is similar to real sputum in viscosity and macroscopic and microscopic appearance; it is also consistent in panel positivity grades. CONCLUSION: The artificial sputum described here could contribute to the EQA and training in tuberculosis laboratories or microscopy centres.

Acetylcysteine↗
PubMed2001

Validation of advanced ECG diagnostic software for the detection of prior myocardial infarction by using nuclear cardiac imaging.

The investigators report the diagnostic performance of the latest version (Version 2.5) of the recently developed Cardiovise algorithm for detecting prior myocardial infarction (MI). The Cardiovise 2.5 prior MI algorithm, a component of Cardiovise Cardiac Diagnostic System (Inovise Medical, Inc, Newberg, OR), uses scalar QRS, scalar T wave, and vectorcardiographic QRS criteria for detecting, sizing, and localizing prior MI. In this study only the detection part of the algorithm's performance was evaluated, using 105 patients with and 98 patients without prior MI as indicated by the results of cardiac imaging with Sestamibi. The specificity, and sensitivity of Cardiovise 2.5 for detecting prior MI in this population of patients are 97% and 79%, respectively. The sensitivity and overall diagnostic performance of Cardiovise 2.5 was significantly better than those of a total of 6 human readers (3 cardiologists and 3 primary care physicians) and to 2 commercially available ECG diagnostic algorithms.

Algorithms↗
PubMedDate not supplied

Diagnostic fetal blood sampling-technique related losses.

BACKGROUND: The applications of cordocentesis are limited by its safety. Cordocentesis is performed either freehand or with the aid of a fixed needle guide. Recent reports suggest a loss rate of 1-7% using the freehand technique. The potential influence of technique on the perinatal loss rate has not been examined. STUDY DESIGN: The procedure-related loss rates of two fetal diagnosis and treatment units, one in the United States (10 operators) and one in Japan (15 operators), who perform diagnostic cordocentesis with the aid of a fixed needle guide is calculated from a prospectively maintained database and compared to the published experience of large centers who use a freehand technique. RESULTS: A total of 1,260 diagnostic cordocenteses were performed. The mean gestation at sampling was 29.1 +/- 5 weeks. The umbilical vein was punctured in 90%. There were 12 procedure-related losses yielding an overall perinatal loss rate of 0.9%. There was no relationship between the risk of a loss and the number of prior procedures the operator had performed. Losses were more often associated with puncture of the umbilical artery (41.7 vs. 9.2%, p = 0.002). Eleven of 12 losses were associated with a postprocedure bradycardia. Eight fetuses who died had either a trisomy or triploidy, 1 had renal agenesis, 2 had severe early-onset growth restriction and 1 had rhesus disease. For all diagnoses other than a chromosome abnormality and severe fetal growth restriction, the procedure-related loss rate from diagnostic cordocentesis was 0.2% (2/1,021). CONCLUSION: This study suggests that technique is a variable in the loss rate for cordocentesis.

Bradycardia↗
PubMed2006

EUS vs MRCP for detection of choledocholithiasis.

BACKGROUND: Numerous published studies have shown the high diagnostic performance of both EUS and MRCP compared with ERCP for the detection of choledocholithiasis. DESIGN: We undertook a systematic review of all published randomized, prospective trials that compared EUS with MRCP with the primary aim being to compare the overall diagnostic accuracy for the detection of choledocholithiasis in patients with suspected biliary disease. METHODS: A MEDLINE review was performed. We identified 5 randomized, prospective, blinded trials comparing MRCP and EUS for the detection of choledocholithiasis, with subsequent ERCP or intraoperative cholangiography as a criterion standard. The study-specific variables for EUS and MRCP for choledocholithiasis were calculated from the data, and analyses were performed by using aggregated variables (sensitivity, specificity, positive and negative predictive values, and likelihood ratios). RESULTS: The pooled data set consisted of 301 patients. The aggregated sensitivities of EUS and MRCP for the detection of choledocholithiasis were 0.93 and 0.85, respectively, whereas their specificities were 0.96 and 0.93, respectively. The aggregated positive predictive values for EUS and MRCP were 0.93 and 0.87, respectively, with the corresponding negative predictive values of 0.96 and 0.92, respectively. Positive likelihood ratios were >10 for both tests, and corresponding negative likelihood ratios approached 0.10 for both tests. No statistically significant differences between EUS and MRCP were found in our analysis. CONCLUSIONS: EUS and MRCP have high diagnostic performance overall. Our analysis showed no statistically significant difference between the modalities. We recommend taking into consideration other factors, such as resource availability, experience, and cost considerations in deciding between these 2 tests.

Cholangiopancreatography, Magnetic Resonance↗
PubMed2026

Integrating metagenomic next-generation sequencing into a multimodal diagnostic framework for spinal infection: enhancing etiological identification and clinical prediction.

BACKGROUND: Spinal infection (SI) remains diagnostically challenging because of heterogeneous etiologies, nonspecific clinical manifestations, and the limited sensitivity of conventional microbiological approaches, particularly following empirical antimicrobial exposure. Although metagenomic next-generation sequencing (mNGS) enables unbiased pathogen detection, its incremental clinical value beyond pathogen identification and its role within integrated diagnostic strategies remain incompletely established. METHODS: We retrospectively analyzed 208 consecutive patients with suspected SI between August 2022 and August 2025. Final diagnoses were established using a multidisciplinary-adjudicated composite reference standard incorporating clinical, radiological, microbiological, and histopathological evidence. The diagnostic performance of mNGS was compared with conventional culture and histopathology. Furthermore, multimodal predictive models integrating clinical variables and microbiological information were developed using L1-regularized logistic regression. RESULTS: In the comparative cohort, mNGS achieved a significantly higher diagnostic yield than culture (66.5% vs. 27.41%, P < 0.001). Among confirmed SI cases, mNGS demonstrated higher sensitivity than conventional culture (91.67% vs. 40.15%, P < 0.001). mNGS identified a substantially broader pathogen spectrum, ranging from fastidious organisms such as Mycobacterium tuberculosis and Brucella to rare pathogens including Talaromyces marneffei and Coxiella burnetii, and maintained robust sensitivity (98.2%) despite prior antibiotic exposure. While an integrated clinical model achieved an AUC of 0.916, mNGS as a standalone modality provided superior discriminative power (AUC = 0.889) compared to histopathology (AUC = 0.836), the Conventional Biomarker Model (AUC = 0.742), and culture (AUC = 0.693). CONCLUSIONS: mNGS is a high-yield diagnostic tool for spinal infection, particularly in culture-negative and antibiotic-pretreated scenarios. Integrating mNGS into a multimodal clinical framework facilitates etiological clarity and precision antimicrobial therapy.

Humans↗
PubMed1999

ROC analysis of three perfusion display options for ECG-gated perfusion SPECT in severe CAD.

AIM: The simultaneous computation and display of wall motion and perfusion patterns in a single 3D ventricular model would considerably ease the assessment of ECG-gated Tc-99m-sestamibi SPECT, yet the effect on the accuracy of allocating regional perfusion has so far not been validated. METHODS: 3D perfusion mapping (3D Perfusion/Motion Map Software) was compared to the visual assessment of ungated tomographic slices and polar perfusion mapping (Cedars-Sinai PTQ) by correlation analysis and receiver operating characteristics (ROC) analysis at different cut-off levels for coronary stenoses in 50 patients (11 single-, 22 two-, 16 three-vessel disease). Ungated SPECT data were obtained by adding the intervals prior to reconstruction and displaying conventional tomographic slices. All display options were visually assessed in 8 ventricular segments according to a 4-point scoring system and compared to the graded results of coronary angiography. RESULTS: All three display options showed a comparable diagnostic performance for the detection of severe stenoses. The diagnostic gain for the detection of stenoses above 59% was highest for ungated tomographic slices, followed by ungated polar mapping and 3D mapping. Regional assessment revealed a limited performance of 3D mapping in the proximal anterior and distal lateral wall. Polar mapping showed a balanced regional performance. CONCLUSION: 3D Perfusion mapping provides comparable information to conventional display options with the highest diagnostic strength in severe stenoses. Further improvement of the algorithm is needed in the definition of the valve plane.

Angina Pectoris↗
PubMed1989

A utility-based model for comparing the cost-effectiveness of diagnostic studies.

The effective cost of a diagnostic test is the money spent per unit of diagnostic performance. The latter can be measured as diagnostic utility (DU), the probability-weighted sum of the utilities of the four test outcomes TP, TN, FP, and FN: DU = U(TP)P(TP) + U(TN)P(TN) + U(FP)P(FP) + U(FN)P(FN). DU (which also is called expected utility) incorporates the clinical decision analytic variables sensitivity (Se), specificity (Sp), equivocal fraction (EF), disease probability (P(D)), and outcome utility (U). DU is not an inherent property of a diagnostic test but of test-observer interactions in a clinical setting. The model sets the effective cost (EC) of a diagnostic test = actual direct cost (ADC)/DU. When DU = 1 (perfect test) EC = ADC and the patient benefits from the test dollar for dollar. When DU less than 1, EC exceeds ADC. If DU approaches O, EC becomes infinite; the test has no effectiveness at any cost. DU depends strongly on P(D) if Se and Sp differ significantly; then EC also depends on P(D), and the effective cost of a test performed in the wrong P(D) setting may be several times its actual direct cost. This model of comparing effective costs compares actual direct cost with clinical measures of test performance and utility values that allow expression of patient/doctor fears and preferences. It offers a more clinically realistic setting than models based on costs alone.

Cost-Benefit Analysis↗
PubMed2000

Safety and efficacy of percutaneous coronary interventions performed immediately after diagnostic catheterization in northern new england and comparison with similar procedures performed later.

"Ad hoc" percutaneous coronary interventions (PCIs)-those performed immediately after diagnostic catheterization-have been reported in earlier studies to be safe with a suggestion of higher risk in certain subgroups. Despite increasing use of this strategy, no data are available in recent years with new device technology. We studied use of an ad hoc strategy in a large regional population to determine its use and outcomes compared with staged procedures. A database from the 6 centers performing PCIs in northern New England and 1 center in Massachusetts was analyzed. During 1997, excluding only patients requiring emergency procedures or those with a prior PCI, 4,136 PCIs were performed, 1,748 (42.3%) of these being ad hoc procedures. Patients having ad hoc procedures were less likely to have peripheral vascular disease, renal failure, prior myocardial infarction, or coronary artery bypass surgery, congestive heart failure, or poor left ventricular function, and more likely to have received preprocedural intravenous heparin or nitroglycerin or to have required an urgent procedure. Narrowings treated during ad hoc procedures were less frequently types B and C or in saphenous vein grafts. Adjusted rates of clinical success were not different between ad hoc and non-ad hoc procedures (93.7% vs 93.6%); there was no difference in the incidence of death (0.6% vs 0.5%), emergency (0. 9% vs 0.8%) or any (1.4% vs 0.8%) coronary artery bypass surgery, or myocardial infarction (2.6% vs 2.0%). As currently practiced in our region, ad hoc intervention is used selectively with outcomes similar for ad hoc and non-ad hoc procedures.

Angina Pectoris↗
PubMed2006

Performance of a predictive rule to distinguish bacterial and viral meningitis.

OBJECTIVE: Although diagnostic performance has recently improved by using new diagnostic methodologies, acute patient management is usually initiated after considering only fairly elementary findings of CSF examination. Using these early findings it is often difficult to distinguish between bacterial and aseptic (viral) meningitis. In order to help distinguish these two categories, scoring tools have been proposed that are more or less complex and validated. METHODS: The aim of this study was to establish a simple scoring tool and compare it to other available decision making systems. We retrospectively analysed all the meningitis cases from our patients at our institution and established a scoring tool for pediatric meningitis and for meningitis in adults by using categorized analysis tree methodology. RESULTS: Main categories for bacterial etiology were, leucocytosis >15 giga, CSF leucocytes count >1700 per ml, CSF neutrophil percentage >80, CSF protein >2.3g/l and glucose CSF/blood ratio <0.33 for adults and CSF leucocytes count >1800, CSF neutrophil percentage >80, CSF protein >1.2g/l and glucose CSF/blood ratio <0.3 for children. Additionally, our new scoring tool and five published ones were compared using our data and two external data sets; from these scores, three, including ours, exhibited good sensitivity and specificity. We then performed several thousand Monte Carlo simulations of both bacterial and viral meningitis for children and adults. We found that our scoring tool (Meningitest) had very high performances with positive and negative predictive values of 97% and 94%, respectively. CONCLUSION: Thus, from this analysis of five meningitis scoring systems, we believe that our new tool is simple, does not need any complex calculation and is effective in identifying bacterial vs viral meningitis in fully immunocompetent children and adults.

Adult↗
PubMed2006

Procalcitonin test in the diagnosis of bacteremia: a meta-analysis.

STUDY OBJECTIVE: We seek to evaluate the diagnostic performance of the procalcitonin test for the diagnosis of bacteremia in the emergency department (ED) population. METHODS: We conducted a search of MEDLINE, bibliographies of previous systemic reviews, and pertinent national meeting research abstracts. We included studies that assessed the diagnostic accuracy of procalcitonin for bacteremia, with blood culture as the reference standard. We included prospective investigations of adults and children with suspected infection studied in the ED or at admission. Two authors independently extracted data and assessed study quality; consensus was reached by conference. The analysis was based on the I2 statistic for heterogeneity, unweighted summary receiver-operating characteristic curve, and random-effects pooled sensitivity and specificity across studies using the same test threshold. RESULTS: The search yielded 348 publications and 1 unpublished study. Seventeen studies met the inclusion criteria and provided a sample of 2,008 subjects. There was a substantial degree of inconsistency (I2=64%). The unweighted summary receiver-operating characteristic curve provided the best overall estimate of test performance, with an area under the curve of 0.84 (95% confidence interval [CI] 0.75 to 0.90). Sensitivity analysis based on study quality did not significantly change the results. Subgroup analysis including only studies that used a test threshold of 0.5 or 0.4 ng/mL yielded pooled estimates for sensitivity and specificity of 76% (95% CI 0.66 to 0.84) and 70% (95% CI 0.60 to 0.79), respectively. CONCLUSION: We found the diagnostic performance of the procalcitonin test for identifying bacteremia in ED patients to be moderate. Future research designed to determine the utility of the procalcitonin test as a diagnostic tool used in isolation for detecting bacteremia in ambulatory patients is needed before widespread clinical use.

Adult↗
PubMed2003

The acute abdomen: a surgeon's approach to diagnosis and treatment.

Clinical approach to a patient with acute abdominal distress involves decision making: whether to take a patient to surgery, or manage the patient medically. A thorough and systematic approach requires the use of diagnostic imaging modalities, including radiology and ultrasonography, performing diagnostic peritoneal lavage or abdominal paracentesis techniques, and bloodwork evaluation, including complete blood count and serum biochemistry profiles. In some cases, the results of diagnostic tests may lead to surgical versus medical management, particularly when a patient fails to respond to medical management alone. In other cases, such as GDV syndrome, penetrating abdominal wounds, pyometra, or uncontrolled abdominal hemorrhage, rapid surgical management is necessary for patient survival. This article describes a systematic approach to a small animal patient with acute abdomen.

Abdomen, Acute↗
PubMed2005

Detecting and monitoring depression with a two-item questionnaire (PHQ-2).

OBJECTIVE: This study evaluates the two-item Patient Health Questionnaire (PHQ-2) as a measure for diagnosing and monitoring depression. METHODS: We assessed construct validity in a cross-sectional sample of 1619 medical outpatients (mean age 43+/-14 years, 64% female) by comparing the PHQ-2 to four longer self-report questionnaires. Criterion validity was established in a subsample of 520 participants with reference to the Structured Clinical Interview for DSM-IV (SCID). Sensitivity to change was investigated in a prospective study of 167 patients who completed the SCID both at baseline and the 1-year follow-up. RESULTS: With reference to the SCID, the PHQ-2 had a sensitivity of 87% and a specificity of 78% for major depressive disorder and a sensitivity of 79% and a specificity of 86% for any depressive disorder. Its diagnostic performance was comparable with that of longer depression scales. PHQ-2 change scores accurately reflected improved, unchanged, and deteriorated depression outcomes. CONCLUSION: The PHQ-2 performed favorably with respect to a standard diagnostic interview, as well as established depression scales and proved sensitive to change. Thus, the PHQ-2 appears promising as a brief multipurpose measure for detecting depression, grading its severity, and monitoring outcomes over time.

Adult↗
PubMed2000

Teaching Diagnostic Skills: Clinical Vignettes or Chief Complaints?

Two formats of case presentation are traditionally used for teaching problem-solving skills: clinical vignette or chief complaint formats. While the first one is more commonly used, it does not completely reflect the actual problem-solving process during a real encounter, which may hamper the learners to integrate separately acquired data gathering skills into their reasoning process and affect their diagnostic performance in practice. The present study compared diagnostic accuracy when the reasoning stimulus was a case vignette containing all diagnostic information versus the patient's chief complaint only. Forty-two medical students, 53 residents and 60 general internists participated in the study. Diagnostic accuracy was significantly lower for the chief complaint format at the student, resident, and practitioner levels. Analysis of the data gathered in the chief-complaint format revealed that faulty diagnostic decisions resulted from a failure to gather critical data. The results suggest that data gathering techniques, semiology, and medical reasoning should be trained in association and that this effort should be pursued beyond medical school.

Journal Article↗
PubMed1999

Analytical quality, performance indices and laboratory service.

Faulty data lead to suboptimal diagnostics and decision making unless the flaw is known and amenable to correction. However, pure noise (added analytical variance) has only minor effects on clinically appropriate indices of diagnostic performance. This fact is illustrated by an idealized screening programme, using the preventive benefit-to-cost ratio as the index of performance. Further, this article illustrates that the effect of an unnoticed source of noise is roughly just twice the effect that the same noise will have when its magnitude is known and clinical decision limits are adjusted accordingly. Owing to the small size of these effects, however, it may be profitable to spend resources on other aspects of good laboratory service, such as timeliness, documentation and interpretative support.

Clinical Laboratory Techniques↗
PubMed1998

Diagnostic accuracy of conventional versus sonography-guided fine-needle aspiration biopsy of thyroid nodules.

Fine-needle aspiration biopsy (FNAB) is an accurate, slightly invasive, and safe method for the preoperative diagnosis of thyroid nodules. Recently, ultrasound guidance has been suggested as a valuable aid to enhance FNAB diagnostic performance. In this study, we have compared diagnostic accuracy of conventional FNAB (C-FNAB) versus sonography-guided FNAB (SG-FNAB) on a large sample population of 9683 patients with thyroid nodules. Over a 15-year period, 4986 patients were investigated by C-FNAB and 4697 underwent SG-FNAB. A valid cytological diagnosis was obtained in 85.9% of C-FNAB and in 91.5% of SG-FNAB cases, allowing detection of thyroid cancer in 1.6% and 2.1% of patients, respectively. The indeterminate pattern of follicular neoplasia was observed in 238 C-FNAB (5%) and in 272 (5.4%) SG-FNAB nodules. Specimens were cytologically inadequate in 433 C-FNAB (8.7%), but only in 167 SG-FNAB cases (3.5%). A total of 535 C-FNAB and 540 SG-FNAB nodules underwent surgery. False-negative results occurred in 7 C-FNAB nodules (2.3%), but only in 3 SG-FNAB cases (1%). Sensitivity, specificity, and global diagnostic accuracy of C-FNAB compared with SG-FNAB were 91.8% versus 97.1%, 68.8% versus 70.9%, and 72.6% versus 75.9%, respectively. Our results, based on a large population of thyroid nodules, demonstrate that SG-FNAB allows a more precise and adequate sampling of thyroid nodular lesions and is associated with a lower rate of false-negatives, thus improving global diagnostic accuracy in the preoperative selection of thyroid cancer.

Adolescent↗
PubMed1993

An evaluation of the multidisciplinary approach to psychiatric diagnosis in elderly people.

OBJECTIVE: To determine the accuracy of psychiatric diagnoses made by two community psychogeriatric teams operating a multidisciplinary assessment procedure. DESIGN: Comparison of team diagnosis with independent formal assessment and consensus diagnosis by research psychiatrists. SETTING: Two community psychogeriatric teams with similar operational policies in an inner London health district. SUBJECTS: 100 people aged 65-90 (70 women) newly referred to the teams. MAIN OUTCOME MEASURES: Concordance between team and research diagnoses. RESULTS: Agreement between team and research diagnoses ranged from 90% to 99% for the specific psychiatric disorders studied. There was no significant difference between medical and non-medical team members in their diagnostic performance compared with the research psychiatrists. Increased diagnostic accuracy by team members was associated with longer experience of team working, regardless of the team members' professional background. CONCLUSIONS: The multidisciplinary approach to the assessment of referrals to these community teams for the elderly is not associated with misdiagnosis of psychiatric disorder.

Aged↗