[log in to unmask],Net wrote at 16:14 on 07/09/98
about "Fungal /dystrophic nails":
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>Can anyone share their experiences with succesful reults of nail
>clippings?
>I seem to score a positive fungus in only about 1 in 10 or even 15
>samples. (including the gungy white crud from under the nail also.)
That may be because only a few of the thick cruddy grungy nails
actually are caused by fungal infction?
Or do we believe that a negative result means we have got the test
wrong? If this was the evidence-based medicine list we would be
well into prior hypotheses and predictive values and SpIn and SpOut
and so on.
I think Hotch and Ahmad's replies are as useful really.
Basically our prescribing adviser - nice, if fearsome lady called
Marilyn Ramsden - would have some temptation to encourage a test
such as that, if she believed it gave false negatives and she
believed that treating toenails was a low priority in the NHS.
IE it causes a number of courses of Lamisil not to be prescribed,
saving money.
Even if the test is actually very reliable in our hands (and
patients' feet), and the diagnosis is usually fungal when it looks
like it (both arguable ideas)
then there is still an incentive to prescribing
advisers and bean counters to encourage doing it before treating with
the expensive antifungal, even if for instance the test cost £30 a
go.
Simply that in NHS management economics, causing money to be spent
later from one budget, by spending freely from somebody else's
budget, is presented as a laudable activity.
Some of this appeared in my Update Editorial which amazingly Grace
thought was accompanied by an attractive picture.
I did a skin scrape today, and found myself remarking to the
accountant it came off, as I struggeld to peel the backing off th
esticky-backed plastic to seal it, on how many manhours were wasted
in the NHS because a tenth of a penny saved by not putting tabs to
grab on tthose transport packs was money saved, whereas time spent
faffing about was money saved.
--- OffRoad 1.9r registered to Adrian Midgley
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