摘要:

Abstract:Clinical decision analysis is a systematic and rigorously logical approach to medical decision making under conditions of uncertainty. The structuring of a clinical problem in a decision analytic framework enables the clinician to focus on one aspect of a complex decision at a time without losing sight of the whole. The concepts of clinical decision analysis are explained and the technique is applied to compare bone marrow transplantation with supportive care for the treatment of a patient with severe aplastic anemia. The advantages and disadvantages of clinical decision analysis are discussed. The technique is intended to complement, but not replace, clinical judgement.

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1983.tb02690.x

出版商:Blackwell Publishing Ltd    

年代:1983

数据来源: WILEY

摘要:

Abstract:Serial measurements of left ventricular short axis dimensions were made to determine reproducibility in ten normal subjects and in ten patients with congestive cardiomyopathy without asynergic wall motion, conduction abnormalities, or arrhythmias, three echocardiograms were performed over a period of three weeks in each subject. In the congestive cardiomyopathy group, mean coefficients of variation for diastolic and systolic left ventricular dimensions (LVIDd, LVIDs) and fractional shortening (FS) were 3.5%, 4.3% and 10.3% respectively. In the normal subjects they were slightly less; LVIDd (2.2%), LVIDs (3.1 %) and FS (8.0%) but the difference was not statistically significant. Coefficients of variation for calculated diastolic and systolic volumes in the normal ventricle group (Teichholz formula) were 5.0% and 7.1% respectively and for ejection fraction, stroke volume and cardiac output 5.8%, 9.8% and 11.8%.The results demonstrate that M‐mode echocardiography is a reliable technique for serial quantitative studies of left ventricular dimensions in both normal subjects, and in selected patients with congestive cardiomyopathy. M‐mode echocardiography may be used to assess the responses of patient groups but not of individual patients to interventions which change ventricular volume and cardiac output in subjects with normal left ventricles in whom good quality endocardial echoes are recor

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1983.tb02691.x

出版商:Blackwell Publishing Ltd    

年代:1983

数据来源: WILEY

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1983.tb02692.x

出版商:Blackwell Publishing Ltd    

年代:1983

数据来源: WILEY

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1983.tb02694.x

出版商:Blackwell Publishing Ltd    

年代:1983

数据来源: WILEY

摘要:

Abstract:Twenty seven gastroenterologists (15 physicians and 12 surgeons) were studied to capture their policy in the usage and weighting of cues in making a diagnosis. This was a relatively small sample and on account of possible sampling bias only tentative generalisations will be made. Five case vignettes, each consisting of four to eight cues, were used. Subjects were asked to give their percentage likelihood estimates of various diagnostic possibilities after each cue. This gave an indication of their perception of the significance of various cues in relationship to each diagnosis. There were marked variations in cue weighting by these experts, and in particular, most individuals were far off the mean regarding the weighting of certain clinical features, thus displaying idiosyncratic behaviour in these instances. As may be expected, there were differences in disease prevalence estimates between physicians and surgeons. Early information had an overwhelming effect on the final diagnosis. In most cases the expert relied on a few critical cues rather than on a pattern to make a diagnosis.In view of the strong influences of early diagnostic formulations, these findings confirm the need for doctors to learn to use and collect accurate factual information on prevalence rates and on the most significant critical cues for various disease processes.The study highlights some of the problems faced by novices in learning from experts who may teach them contradictory information about what are the most significant factors in coming to a diagnosis.

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1983.tb02695.x

出版商:Blackwell Publishing Ltd    

年代:1983

数据来源: WILEY

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1983.tb02696.x

出版商:Blackwell Publishing Ltd    

年代:1983

数据来源: WILEY

摘要:

Abstract:We retrospectively reviewed 100 consecutive autopsies performed at the Royal Adelaide Hospital in 1979. The review was made jointly by a clinician, surgical pathologist and forensic pathologist. The mean patient age was 64.5 years. Sixteen percent of premortem anatomical diagnoses were not confirmed at autopsy. Autopsy revealed 171 new anatomical diagnoses. Of these, 33 diagnoses in 27 patients were important in relation to the cause of death and if known premortem would have altered therapy and possibly outcome in two patients. In 11 cases the missed major diagnoses should have been entertained on the basis of available clinical data. Of the 19 sudden deaths, the cause of death was not included in the clinical differential diagnosis in seven cases. Autopsy resulted in a substantial change in the death certification of 43 cases. The data indicate that the autopsy has a great deal to offer in correcting clinical diagnoses and effecting scientific discipline for clinicians.

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1983.tb02697.x

出版商:Blackwell Publishing Ltd    

年代:1983

数据来源: WILEY

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1983.tb02698.x

出版商:Blackwell Publishing Ltd    

年代:1983

数据来源: WILEY

摘要:

Abstract:Immunogenetic factors are important in systemic lupus erythematosus (SLE) and deficiency of a number of complement components is often associated with a lupuslike illness. The complement components Bf, C2 and C4 are encoded within the human major histocompatibility complex (MHC) and are polymorphic. A study of HLA and Bf and C4 polymorphism in 43 patients with SLE was undertaken firstly, to determine whether partial deficiency of C2 and C4 may predispose to disease and secondly, because it may allow the better definition of important supratypes associated with the disease and which may include the relevant disease gene(s).An increased frequency of C4A null alleles has been shown in SLE, with a minimal estimated C4A null gene frequency of 0.32 versus 0.20, but no case of partial C2 deficiency was identified. These results may indicate a direct role for partial C4 deficiency or that C4A null may be a marker for an important supratype which includes the relevant disease gene(s).

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1983.tb02699.x

出版商:Blackwell Publishing Ltd    

年代:1983

数据来源: WILEY

摘要:

Abstract:This paper is a study of 117 patients with endstage renal failure, treated by continuous ambulatory peritoneal dialysis (CAPD) over periods of 1–56 months. The study has shown CAPD to be an effective form of dialysis with a number of advantages over intermittent peritoneal dialysis and hemodialysis (better control of salt and water status, hypertension and anemia, steady state biochemistry and greater ease of self‐dialysis). Peritoneal clearance and ultrafiltration have remained adequate in all but a few patients. Hypoproteinemia, poor nutrition, obesity and abdominal herniae have been problems in a small percentage of patients. Hyperlipidemia has developed in half the patients but improved with diet. Peritonitis remains the major barrier to the more widespread use of CAPD, although its incidence can be considerably reduced by use of better connectors, bacterial filters and choice of patie

ISSN:0004-8291    

DOI:10.1111/j.1445-5994.1983.tb02700.x

出版商:Blackwell Publishing Ltd    

年代:1983

数据来源: WILEY