Appropriate investigation and treatment in clinical practice
İÇİNDEKİLER1 Why do we investigate patients? by Anthony Dawson . . 1References . . . . . . . . . . . 4 2 Rational use of investigations in clinical practice by Nicholas Wald. . . . . . . . . 7 Six relevant questions . . . . . . . . 8 Performance parameters of a test . . . . . . 9 Flow charting . . . . . . . . . . 12 Likelihood ratio . . . . . . . . . . 12 What value of a test does not alter the risk of having the disorder being tested for? . . . . . . . . . 14 Examples of the application of the quantitative approach to clinical investigation . . . . . . . . . 14 Conclusions . . . . . . . . . . 19 Acknowledgements . . . . . . . . . 19 References . . . . . . . . . . . 19 3 How do we decide whether an investigation or procedure is appropriate? by Mark Chassin . . . . . . . Measuring appropriateness . . . . . . . 21 Results . . . . . . . . . . . 27 Conclusions . . . . . . . . . . 28 References . . . . . . . . . . . 28 Appropriate use of investigations in cardiology " by jia-ji Yi, john .M. Rowleyz and john R. Hampton . . . 31 Audit by observation . . . . . . . . . 32 Limitations of observational audit . . . . . . 35 Appropriateness assessed by cross-cultural comparisons . . 35 Under-utilisation of investigations . . . . . . 39 Conclusions . . . . . . . .` . . 40 References . ,. . . . . . . . . . 40 5 Appropriate use of investigations in gastroenterology by Christopher Mallinson . . . . . . . . 41 Dyspepsia . . . . . . . . . . . 41 Upper gastrointestinal haemorrhage . . . . . . 47 Lower abdominal pain . . . . . . . . 49 Rectal bleeding . . . . . . . . . . 54 Conclusion . . . . . . . . . . 55 References . . . . . . . . . . . 55 6 Clinical features and appropriate investigations in neurological practice by Anthony Hopkins . . . . . 59 Headache . . . . . . . . . . . 61 Epilepsy . . . . . . . . . . . 65 Multiple sclerosis . . . . . . . . . 71 References . . . . . . . . . . . 75 7 The agenda for outcomes research by john E. Wennberg . . 77 References . . . . . . . . . . . 80 Appendix: . . . . . . . . . . An assessment of prostatectomy for benign urinary tract obstruction: geographical variations and the evaluation of o medical care outcomes by j. E. Wennberg, A. G. Mulley, D. Hanley et ali (Reprinted from the journal of the American , Medical Association) .......81 8 Experience in the private sector by Alan Bailey . . . 91 Variability . . . . . . . . . . 92 Idiosyncrasy . . . . . . . . . . 93 References . . . . . . . . . . . 95 9 Translating good ideas into appropriate action by Cyril Chantler, Gordon Me. Coehrane ana' Iden Wiekings . . 97 Clinical freedom . . . . . . . . . 97 Motivation for change . . . . . . . . 98 Resource management . . . . . . . . 99 Medical audit . . . . . . . . . . 100 NHS research and development . . . . . . . 101 Conclusion . . . . . . . . . . 102 References . . . . . . . . . . . 102 10 Towards appropriate clinical practice: some reflections by Robert Maxwell . . . . . . . . . 105  |
