12881 - Outline of presentation 1) 2) 3) 4) 5) 6) 7) Key...

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Outline of presentation 1)  Key messages 2)  HFA 3)  Thoughtful physicians: Difficult Questions 4)  EBM 5)  Measurement Iterative Loop 6)  COPCORD / WHO / ILAR Studies 7)  In conclusion ……
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Listen Listen Listen hypotheses cross examine to gather  data for hypothesis testing test hypotheses is one of the  hypotheses valid? TAKE ACTION The cyclic process of differential diagnosis NO YES
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How do I select the appropriate diagnostic test? 1)  Diagnostic tests RARELY  reveal a patient’s true  state with certainty. 2)  Test selection should be restricted  to those             diagnostic tests whose results could change              physician’s mind as to what should be done  for a patient. 3)Physicians often start treatment despite           uncertainty  about true state of patient.
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Number of diagnostic hypotheses remaining during The steps of evaluating a symptom 0 5 10 15 c h ie f c o m p la in t h isto ry p h ysic a l e xa m te sts Number  of  diagnoses  to be  considered chief  complaint history physical  exam tests
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Equal chance of  occurring or not  occurring Certain not  to occur Probability of disease  -  1 0 0.5 1.0 Certain  to occur
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Posterior  Probability Prior  Probability Probability of disease - 2 0 0.5 1.0
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P[disease] = 0.06 Probability of disease  -  3 0 0.5 1.0
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1)  Convert information needs into answerable questions 2)  Track down, with maximum efficiency, the best  evidence with which to answer them (from the clinical  examination, the diagnostic laboratory, the published  literature, or other sources) 3)  Critically appraise that evidence performance for its  usefulness (clinical  applicability) 4)  Apply the results of this appraisal in clinical practice 5)  Evaluate performance  
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Best Evidence Clinical knowledge,  experience,  skills,  guts,  flair Patient  Preferences  Fig : Flowchart of evidence-based medicine (adapted from Jenicek 7 ) Diagnosis, Therapy, Prognosis Performance
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Clinical aphorisms 1)  If you hear hoofbeats, think of horses not zebras 2)Rare manifestations of common diseases  are          often more likely than common manifestations  of 
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This note was uploaded on 02/23/2012 for the course PHARM 290 taught by Professor Staff during the Fall '10 term at Rutgers.

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12881 - Outline of presentation 1) 2) 3) 4) 5) 6) 7) Key...

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