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EVIDENCE-BASED-HEALTH  January 2005

EVIDENCE-BASED-HEALTH January 2005

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Subject:

Re: Thread on diagnostic testing

From:

Dan Mayer <[log in to unmask]>

Reply-To:

Dan Mayer <[log in to unmask]>

Date:

Mon, 3 Jan 2005 11:04:27 -0500

Content-Type:

text/plain

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text/plain (87 lines)

Ben and the list,

Thanks for your comment Ben.  I agree with you 100% and see no
disservice to my comments.  I think that we are saying the same thing
and am glad that you amplified on the issue.  There are too many
instances when a test ought not be done since the result will not change
pretest probability enough and we either will or won't treat regardless
of the result.  Thanks for sending on your example,

Best wishes

Dan

****************************************************************************
Dan Mayer, MD
Professor of Emergency Medicine
Albany Medical College
47 New Scotland Ave.
Albany, NY,  12208
Ph; 518-262-6180
FAX; 518-262-5029
E-mail; [log in to unmask]
****************************************************************************

>>> "Djulbegovic, Benjamin" <[log in to unmask]> 12/30/2004
9:05:25 AM >>>

Dan, sorry if I am doing some disservice to your thoughtful note on
diagnostic testing issues that you and the rest of us think "are
extremely important to the use of EBM in the ongoing practice of
medicine." However, I want to comment on one aspect of your note. I
agree with you that the reasons for ordering the test can help clarify
should the test be ordered or not, and how it should be interpreted. As
you said, " For the care of an individual patient, we look for the
therapeutic or diagnostic benefits to the patient as a result of the
clinician being more certain about the diagnoses (and that leading to a
change in therapy or prognosis)." In these situations, ordering a
diagnostic test can be actually linked directly to the evidence on
benefits and harms of treatment that we may have in mind. For example,
several years ago we "played" with integration of various evidence-based
medicine therapeutic summary measures within the context of simple
clinical decision analysis in order to find out that a diagnostic test
should never be ordered if the harm of treatment is greater than or
equal to its benefit (see http://www.medscape.com/viewarticle/403613).
That is, our decision about using DIAGNOSTIC tests (at bedside) are
ultimately linked to our knowledge about our TREATMENTS. So, perhaps
indeed we can develop "A hierarchical outcomes approach to test
assessment" as advocated in the reference you cited.

best

ben


Benjamin Djulbegovic, MD,PhD
Professor of Oncology and Medicine
H. Lee Moffitt Cancer Center & Research Institute
at the University of South Florida
Department of Interdisciplinary Oncology
SRB #4, Floor 4, Rm #24031 (Rm# West 31)
12902 Magnolia Drive
Tampa, FL 33612

Editor: Cancer Treatment Reviews (Evidence-based Oncology Section)
http://www.harcourt-international.com/journals/ctrv/


e-mail:[log in to unmask]
http://www.hsc.usf.edu/~bdjulbeg/
phone:(813)979-7202
fax:(813)979-3071






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