When is a test result abnormal?: defining limits and risks

Article Abstract:

Decisions regarding diagnosis or risk for disease are often based on 'normal' or 'not normal' laboratory results. When test results from normal and not-normal people overlap, diagnosis may not be correct. A cutoff of 'normal' is chosen to balance the risk of false positive and false negative results. Actually what is obtained from the results of lab tests is not a diagnosis, but the probability of a diagnosis. The authors present a statistical method for evaluating the degree of overlap of normal and not-normal results, and for quantifying the risk of incorrect diagnosis. The method is illustrated by its application to a medical screening program for carriers of the genetic disease Tay-Sachs. This statistical method allows diagnostic criteria to be defined and evaluated based on relatively small samples. An inconclusive range was used to reduce the risk of incorrect diagnosis due to borderline results or measurement error. The parameters for normal, inconclusive and not-normal are based on the probability of misdiagnosis, the anticipated incidence of inconclusive diagnoses, and the ability of the test to be reproduced. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Statistics, Statistics (Data), Medical statistics, Diagnosis, Laboratory, Laboratory diagnosis

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Black clouds: work load, sleep, and resident reputation

Article Abstract:

Perception of workload among medical residents appears to be affected more strongly by amount of sleep than by actual workload. In one program, residents who consistently seem to have more difficulties during on-call hours - more patient admissions, more patients, more patient deaths - are said to be under a 'black cloud.' Over the period of about one year, 19 first-year pediatric residents rated their work load and recorded the following information after each night on call: hours of sleep and the actual number of admissions, patients, deaths, births and transfers to the pediatric intensive care unit for which they were responsible. To determine the first-year residents' reputations, all residents were asked to rate each other's work load as light, average or heavy. There were no differences in actual work load among the 19 residents, but perception of their work loads varied significantly. Sleep predicted perceived work load more than any other factor, and the residents with reputations for heavy work loads got less sleep while on call than other residents.

Psychological aspects, Practice, Sleep deprivation

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Pediatric resident support group: a 7-year longitudinal experience

Article Abstract:

A support group for pediatric residents may be an effective way to reduce stress and enhance professional cooperation. One pediatric residency program has had a weekly lunch meeting for seven years. Only residents and interns are invited, and attendance is voluntary. The group has two co-leaders, a child psychiatrist and his wife, a pediatrician. The co-leaders facilitate respectful communication and keep discussions on track. Subjects discussed include professional concerns, such as working relationships and difficult cases, and personal matters, such as balancing work and family. Matters discussed are kept confidential so group members can be free to share thoughts and feelings. Attendance and enthusiasm for the program have remained high throughout the years.

Associations, Self-help groups, Self help groups

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