http://www.primarycare.ox.ac.uk/journalwatch
From Richard Lehman's latest edition of Journal Watch;
> 816 The little bits of research I have done in my GP career have
> involved case-finding in primary care using new diagnostic tests –
> endomysial antibody for coeliac disease, B-type natriuretic peptide
> for heart failure and holotransocobalamin for functional B12
> deficiency (though others did the real work). This brought home to
> me the difficulties of comparing the new test with the current
> reference standard, because changing the test can mean radically
> changing our picture of the disease: coeliac patients are no longer
> withered children but often asymptomatic adults. So how do you
> compare and validate the new test against the old? If there really
> was a “gold standard” we would all be using it anyway. Oddly
> enough, this ground-breaking paper suggests that it is possible to
> compare two silver level tests by using a bronze-level “fair
> umpire” test. If you want to know how, you must read this paper,
> written by three of the clearest thinkers in the field, Paul
> Glasziou, Les Irwig and Jon Deeks. It is beautifully written but
> needs twenty uninterrupted minutes, a clear head and a cup of
> coffee (unless you are pregnant): it is destined to become a
> classic of the diagnostic literature. http://www.annals.org/cgi/
> content/abstract/149/11/816
>
Jonathan
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