doi: 10.1093/labmed/22.10.695pmid: N/A
Article PDF first page preview Close This content is only available as a PDF. © American Society of Clinical Pathologists
doi: 10.1093/labmed/22.10.698pmid: N/A
Article PDF first page preview Close This content is only available as a PDF. © American Society of Clinical Pathologists
doi: 10.1093/labmed/22.10.701pmid: N/A
Article PDF first page preview Close This content is only available as a PDF. © American Society of Clinical Pathologists
doi: 10.1093/labmed/22.10.707pmid: N/A
Article PDF first page preview Close This content is only available as a PDF. © American Society of Clinical Pathologists
doi: 10.1093/labmed/22.10.708pmid: N/A
Abstract The intrinsic ability of a diagnostic test or system to discriminate between two states of health constitutes its accuracy in the purest sense. Information about this accuracy can be readily obtained by the laboratorian using receiver (or relative) operating characteristic curve analysis, and may be helpful in making some of the decisions normally encountered in laboratory practice. This content is only available as a PDF. © American Society of Clinical Pathologists
doi: 10.1093/labmed/22.10.712pmid: N/A
Abstract In this article I review bayesian approaches to interpretative reporting of laboratory tests. Extensions to Galen and Gambino’s four-cell predictive value matrix are discussed, in terms of the types of analytical results they engender. The article concludes with relative operating characteristic analysis, a global method of test performance measurement. Throughout the article an example problem in iron deficiency anemia diagnosis is maintained. This content is only available as a PDF. © American Society of Clinical Pathologists
doi: 10.1093/labmed/22.10.718pmid: N/A
Abstract Comprehensive assessment of the clinical value of diagnostic tests requires demonstration of technical capacity, diagnostic accuracy, and therapeutic impacts. A test shows technical capability if it detects a condition with reproducible results. Sensitivity, specificity, and receiver operating characteristic statistics permit assessment of tests according to standards of accuracy. Therapeutic efficacy assessment addresses whether a test improves therapy or outcomes more successfully than its predecessors. Therapeutic efficacy may be assessed through a randomized clinical trial or may be modeled using decision analysis. The threshold model is a special case of decision analysis with a focus on the change in expected utility (value) of test information as the probability of disease changes. Decision thresholds are specific probabilities of disease where the preferred course of action changes from observation to testing or from testing to initiating treatment. Thresholds depend on the utilities assigned to outcomes and on the accuracy statistics associated with relevant tests, but do not depend on the prior probability of disease. Prior probability estimates are derived from features of the history or physical findings, and comparison of prior probabilities to the threshold probabilities determines the most useful course of action. Assessment of diagnostic tests goes beyond determination of accuracy. For complex tests or rare diseases, decision analytic models offer useful assessments when randomized trials may not be feasible. This content is only available as a PDF. © American Society of Clinical Pathologists
Spackman, Kent, A.;Robert Beck,, J.
doi: 10.1093/labmed/22.10.725pmid: N/A
Abstract A laboratory report that effectively communicates to the ordering physician is an essential component of the total testing process. The design of effective reports, while properly within the scope of medical informatics and clinical pathology, is still as much an art as a science. Nevertheless, some basic principles and techniques are becoming apparent. This article examines the state of the art in laboratory reporting, focusing on both printed reports and computer-generated graphic reports. We conclude that currently used reporting methods need to be improved, and users of laboratory information systems can make some of these improvements themselves while encouraging the Laboratory Information System vendor community to assist with others. This content is only available as a PDF. © American Society of Clinical Pathologists
Healy, James, C.;Bozek, Steven, A.
doi: 10.1093/labmed/22.10.728pmid: N/A
Abstract We describe the Wright-Giemsa program, a microcomputer-based system for the creation and subsequent presentation of peripheral blood smears to medical students. Smear characteristics are entered by the author, and the program then translates these characteristics into a peripheral smear for presentation. Smears are stored as maps that describe the placement of individual cellular elements. At presentation, smears are created from the map by placing individual cell images from a cell library onto the computer screen. The cell library is created and maintained by the author, who may also create a customized glossary of terms or atlas of smears and cells. The author can selectively enhance the student environment to include quizzes or student interpretation of the smear. Information about the session can be saved on disk for use by another program. Faculty and student experience with the system has been favorable. A pilot study was also carried out involving sophomore medical students. We discuss the process involved in the creation and use of such a system. This content is only available as a PDF. Author notes This paper was presented, in part, at the Thirteenth Annual Symposium on Computer Applications in Medical Care, Washington, DC, November 8, 1989. © American Society of Clinical Pathologists
Healy, James, C.;Therkildsen,, David;Fleming,, Craig;Korth,, Patricia;Robert Beck,, J.
doi: 10.1093/labmed/22.10.732pmid: N/A
Abstract Physicians frequently make decisions in cases where the best alternative is unclear. Often two or three courses of action are under consideration, each with significant risks and benefits. The process of clinical decision analysis provides a framework within which decisions can be made under uncertainty. Risks and benefits can be quantified, and the relationship between various factors can be assessed. In this article we discuss the process of clinical decision analysis as applied to Transfusion Medicine. The case discussed involves chronic gastrointestinal bleeding for which surgical intervention is expected to be of limited benefit. The patient is unable to tolerate iron or erythropoeitin therapy. The alternative to surgery is red blood cell transfusions on an as-needed basis. How risky is transfusion? How will long-term transfusion therapy affect her life expectancy? What if surgery doesn’t work? This content is only available as a PDF. Author notes Presented, in part, at the Society for Decision Making, Minneapolis, Minn, October 15, 1989. © American Society of Clinical Pathologists
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