Cassandra and the clinician: are clinical prediction rules changing the practice of medicine?
Article Abstract:
One of the major challenges facing the medical profession is reconciling the absolute need for accurate diagnosis of disease with the extraordinarily high cost of obtaining the greatest diagnostic accuracy using available technology. The creation of clinical prediction rules has addressed this conflict; the approach assesses a set of medical symptoms and signs to predict associated diagnoses or outcomes. An article by Heckerling and coworkers in the November 1, 1990 issue of the Annals of Internal Medicine, which addresses the predictive signs of pneumonia, provides a model of how clinical prediction rules should be established and used. However, no matter how accurate such rules are, it may be impossible to avoid the extra tests that are supposed to be unnecessary when using clinical prediction rules. Barriers may include patients' demands and clinicians' desires to avoid malpractice litigation. Prediction rules are effective only if they improve patient care; this factor is not always evaluated in studies of this methodology. Another problem with this approach is that disease may occur in the presence of partial, as well as complete, groups of symptoms; at what cut-off level should the additional test not be conducted for the possible, but improbable diagnosis? Until quality care and cost modulation can meet in the same proposed guidelines for diagnosis, clinical prediction rules are not likely to change the practice of medicine. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Annals of Internal Medicine
Subject: Health
ISSN: 0003-4819
Year: 1990
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A new mechanism for controlling the number of red cells in the blood
Article Abstract:
The body can control the number of red blood cells by destroying newly made cells as well as older cells. Normally only the oldest cells are destroyed, but in nine men who descended to sea level after living in the mountains of Peru, young blood cells were preferentially destroyed. This process also occurs in astronauts.
Publication Name: Annals of Internal Medicine
Subject: Health
ISSN: 0003-4819
Year: 2001
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