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Clinical Skills

Even more about more on diagnostic testing

It’s like a sore spot I can’t stop poking! If you’ve been following this blog you will have read a number of submissions by my colleague Dana Lawrence and myself on the shortcomings of Sensitivity and Specificity in clinical decision making. From a clinician’s point of view you really need to use likelihood ratios....
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What are you communicating?

A recent study conducted by Bourquin et al., investigated the use of technical language by medical students in simulated patient interviews.(1) Investigators found that medical students often communicated by using words that were unfamiliar or confusing to patients. A few of the words used without explanation and that were unclear for patients included chemotherapy,...
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Outcome Switching in Scientific Publication

Much of my career has been spent working in part as a journal editor, as a scientist and researcher, and as a teacher. In my current teaching position, I teach a course on evidence-based chiropractic practice. Part of that course is given over to critical appraisal of literature. The reason for placing emphasis on...
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High Blood Pressure

When doing vitals during a patient evaluation would it be a surprise to anyone to find a patient has hypertension? Of course not. Hypertension is extremely common. In fact it is estimated that worldwide 41% of those between 35 and 70 are hypertensive. Additionally, less than half of them aware they have the diagnosis....
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And Even More on Diagnostic Testing

Our last two blog posts, by myself and my colleague John Stites, have dealt with issues related to diagnostic testing. I discussed the importance of cut-off points and how changing them affects the sensitivity and specificity of a test. John discussed the concept of SPin and SNout and related cautions in interpreting them. Let...
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The Importance of a Cut-Off Point

In the last column, my colleague Dr. John Stites provided additional insight into the concept of SpIN and SnOut, which are related to the larger concept of sensitivity and specificity. To remind you, sensitivity is the percentage of people who have the disorder in question and whom test positive on a given diagnostic test....
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Cautions on SpIn and SnOut

Many of us have heard about SpIn and SnOut. The mnemonic helps to remind us that very Specific tests help to rule in a disorder (Sp = specific, In = rule in) and very Sensitive tests help to rule out a disorder (Sn = sensitive, Out = rule out). I usually don’t teach this...
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At the Speed of Light

I am reading a book which, on its surface, may seem to have little to do with evidence-based practice. The book is “Virtual Unreality,” by Charles Seife. It is about how the internet allows us to spread information faster than we have ever seen before, while reaching more people in more rapid a time...
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Some Thoughts on Evidence-Based Practice and Decision Making

Dr. Tricia Greenhlagh has been someone who has immensely influenced my thinking. She is a professor of primary care health sciences at the University of Oxford, and she wrote a great little book called “How to Read a Paper: The Basics of Evidence-Based Medicine.” (1) She now also adds a blog to her list...
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The Evidence Hierarchy Evolving

By now, we have all been exposed to the evidence pyramid. This is a graphic that demonstrates the apparen6t hierarchy of scientific papers, with those with the least rigor located at the bottom of the pyramid, and those with the most at the top. So, we have anecdote and case reports located near bottom,...
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