Abstract:
PURPOSE:Whilst core curricula in neurology are nationally standardised, in real-world clinical practice, different approaches may be taken by individual consultants. The aims of this study were to investigate differences by assessing: (a) variance in diagnostic and investigative practice, using a case-based analysis of inter-rater agreement; (b) potential importance of any differences in terms of patient care; (c) relationships between clinical experience, diagnostic certainty, diagnostic peer-agreement and investigative approach. The objective was to develop novel individualised metrics to facilitate reflection and appraisal. METHODS:Three neurologists with 6-23 years' experience at consultant level provided diagnosis, certainty (10-point Likert scale), and investigative approach for 200 consecutive general neurology outpatients seen by a newly qualified consultant in 2015. Diagnostic agreement was evaluated by percentage agreement. The potential importance of any diagnostic differences on patient outcome was assigned a score (6-point Likert scale) by the evaluating neurologist. Associations between diagnostic agreement, certainty and investigative approach were assessed using Spearman correlation, logistic and ordinal regression, and reported as individualised metrics for each rater. RESULTS:Diagnostic peer-agreement was 3/3, 2/3 and 1/3 in 55.5%, 31.0% and 13.5% of cases, respectively. In 15.5%, differences in patient management were judged potentially important. Investigation rates were 42%-73%. Mean diagnostic certainty ranged from 6.63/10 (SD 1.98) to 7.72/10 (SD 2.20) between least and most experienced consultants. Greater diagnostic certainty was associated with greater diagnostic peer-agreement (individual-rater regression coefficients 0.33-0.44, P < .01) and lower odds of arranging investigations (individual-rater odds ratios 0.56-0.71, P < .01). CONCLUSIONS:It appears that variance in diagnostic and investigative practice between consultant neurologists exists and may result in differing management. Mean diagnostic certainty was associated with greater diagnostic peer-agreement and lower investigation rates. Metrics reflecting concordance with peers, and relationships to diagnostic confidence, could be developed in larger cohorts to inform reflective practice.
journal_name
Int J Clin Practjournal_title
International journal of clinical practiceauthors
Aitchison C,Blackburn DJ,Khan A,Grünewald RA,Jenkins TMdoi
10.1111/ijcp.13830subject
Has Abstractpub_date
2020-11-12 00:00:00pages
e13830eissn
1368-5031issn
1742-1241pub_type
杂志文章abstract::A 43-year-old female patient with Basedow-Graves' disease developed agranulocytosis in the eighth month of propylthiouracil therapy. After discontinuing the drug, a broad spectrum antibiotic regimen plus recombinant human granulocyte colony-stimulating factor (G-CSF), a human haematopoietic growth factor, were started...
journal_title:International journal of clinical practice
pub_type: 杂志文章
doi:
更新日期:1999-07-01 00:00:00
abstract:AIMS:We prospectively enrolled 207 patients (121 were 75 or older and 86 younger than 75) who were admitted to three Respiratory Monitoring Units. The primary outcomes were intubation and mortality rates; the secondary outcomes were changes in arterial blood gases analysis, non-invasive ventilation (NIV) duration and l...
journal_title:International journal of clinical practice
pub_type: 杂志文章
doi:10.1111/ijcp.12484
更新日期:2014-12-01 00:00:00
abstract::Both the incidence of twin pregnancy and the demand for prenatal diagnosis are increasing. Unfortunately, biochemical screening and ultrasound scanning are less reliable for prenatal diagnosis in twin pregnancies than in singletons. Amniocentesis and chorionic villous biopsy are usually diagnostic in singleton pregnan...
journal_title:International journal of clinical practice
pub_type: 杂志文章,评审
doi:
更新日期:1997-07-01 00:00:00
abstract:BACKGROUND:In 2006, the American Diabetes Association and the European Association for the Study of Diabetes established a consensus algorithm (ADA/EASD-2006) for the adjustment of drug therapy for type 2 diabetes mellitus (T2DM). AIMS:To study glycaemic control in T2DM patients and the implementation of the ADA/EASD-...
journal_title:International journal of clinical practice
pub_type: 杂志文章,多中心研究
doi:10.1111/ijcp.12251
更新日期:2014-01-01 00:00:00
abstract::Hepatic endometriosis is extremely rare. The diagnosis is often missed and treatment is delayed. A 37-year-old woman was referred to the gynaecology department with vague abdominal pains. She had a past history of pelvic endometriosis and hysterectomy with bilateral salpingo-oophorectomy. Further investigations in due...
journal_title:International journal of clinical practice
pub_type: 杂志文章
doi:
更新日期:2001-05-01 00:00:00
abstract:BACKGROUND:There has been a dramatic increase in the incidence of immediate breast reconstruction after mastectomy for breast cancer over the past few decades and autologous tissue flaps are being used with increasing frequency. Concern has been expressed that these complex procedures may lead to a delay in the deliver...
journal_title:International journal of clinical practice
pub_type: 杂志文章,评审
doi:10.1111/j.1742-1241.2009.02199.x
更新日期:2009-11-01 00:00:00
abstract:OBJECTIVE:The objectives of this study were to compare the performance indicators of risk-adjustment models based on administrative and clinical data in Korea, and to assess whether administrative data alone is useful for comparing quality of care. METHODS:Outcome was defined as death within 30 days of discharge. For ...
journal_title:International journal of clinical practice
pub_type: 杂志文章,多中心研究
doi:10.1111/j.1742-1241.2007.01345.x
更新日期:2007-07-01 00:00:00
abstract::Motor restlessness, characterised by an irresistible urge to move about, can be a manifestation of many underlying disorders. Unfortunately, it is often poorly recognised and underdiagnosed in clinical practice, possibly because patients do not seek medical attention, or their complaints were thought to be secondary t...
journal_title:International journal of clinical practice
pub_type: 杂志文章
doi:
更新日期:2001-06-01 00:00:00
abstract:IMPORTANCE:There is an ever-increasing drive to improve surgical patient outcomes. Given the benefits which robotics has bestowed upon a wide range of industries, from vehicle manufacturing to space exploration, robots have been highlighted by many as essential for continued improvements in surgery. OBJECTIVE:The goal...
journal_title:International journal of clinical practice
pub_type: 杂志文章,评审
doi:10.1111/ijcp.12492
更新日期:2014-11-01 00:00:00
abstract:AIMS:Patients with advanced type 2 diabetes (T2D) and high glycated haemoglobin (HbA1c) values can be difficult to treat because of their severe metabolic disease. This pooled analysis examined the treatment effects of exenatide twice daily (BID), exenatide once weekly (QW) and insulin in patients with high baseline Hb...
journal_title:International journal of clinical practice
pub_type: 杂志文章,meta分析,评审
doi:10.1111/ijcp.13029
更新日期:2017-12-01 00:00:00
abstract:AIM:To assess the efficacy and safety of dipeptidyl peptidase 4-inhibitors (DPP4-I) compared with sulphonylureas in adults with type 2 diabetes (T2D) mellitus. METHOD:Randomised controlled trials were collected from PubMed, EMBASE, Google Scholar and conference. The primary outcome was the change in HbA1c. Secondary o...
journal_title:International journal of clinical practice
pub_type: 杂志文章,meta分析,评审
doi:10.1111/ijcp.12761
更新日期:2016-02-01 00:00:00
abstract::Influences on bladder health begin during infancy and continue throughout the lifespan. Bladder anatomy and physiology change as individuals age, and the risk and propensity for bladder conditions, including lower urinary tract symptoms, throughout life are related to factors specific to age, sex, and life events. Bla...
journal_title:International journal of clinical practice
pub_type: 杂志文章
doi:10.1111/ijcp.12127
更新日期:2013-05-01 00:00:00
abstract:BACKGROUND/AIMS:The consumption of soft drinks has increased considerably during the last decades. Among them, the cola-based preparations are possibly the refreshments with the largest sales worldwide. In addition to the possible detrimental effects of moderate, chronic cola consumption, it has been proposed that the ...
journal_title:International journal of clinical practice
pub_type: 杂志文章,评审
doi:10.1111/j.1742-1241.2009.02051.x
更新日期:2009-06-01 00:00:00
abstract:PURPOSE:In the setting of an increasing workload for radiologists, this study focuses on the feasibility of skill mixing in breast imaging in a hospital radiology department. METHODS:Two radiological technologists with more than 10 years of experience in performing mammograms were trained in prereading mammograms to s...
journal_title:International journal of clinical practice
pub_type: 杂志文章
doi:10.1111/j.1742-1241.2009.02310.x
更新日期:2010-03-01 00:00:00
abstract::In this journal, Cummins et al reported an experiment that examined clinicians' predictions of causes of death from subjects' pre-morbid photographs. They found that clinicians performed at chance. The validity of two of their other conclusions are challenged. First, that clinicians routinely form impressions of how a...
journal_title:International journal of clinical practice
pub_type: 评论,杂志文章
doi:
更新日期:2000-03-01 00:00:00
abstract:BACKGROUND:Although the relationship of elevated serum uric acid levels and cardiovascular disease has been established in a great number of studies, the causal relevance of this finding remains ambiguous. An approach to evaluate the causal relevance of biomarkers is to exploit the natural randomised allocation of alle...
journal_title:International journal of clinical practice
pub_type: 杂志文章,评审
doi:10.1111/ijcp.13048
更新日期:2018-01-01 00:00:00
abstract::The purpose of this survey was to ascertain which physiotherapy techniques are currently used, how interventions are assessed and to determine the views of physiotherapists in the UK on the need for further research. Senior physiotherapists in 100 randomly selected hospitals providing respiratory care in the UK were s...
journal_title:International journal of clinical practice
pub_type: 杂志文章
doi:
更新日期:2002-01-01 00:00:00
abstract::Cystic fibrosis (CF) is one of the commonest lethal inherited conditions among Caucasians. It affects multiple organ systems and exhibits a range of clinical problems of varying severity. Life expectancy has improved in recent years as treatment regimes have become more intensive, but current treatments are expensive,...
journal_title:International journal of clinical practice
pub_type: 杂志文章,评审
doi:
更新日期:2000-04-01 00:00:00
abstract::Non-small cell lung cancer (NSCLC) is the most lethal of the common solid malignancies. It is predominantly a disease of the elderly with the median age at diagnosis 68 years. Unfortunately, the majority of patients present with advanced disease whereby palliation is the primary aim of treatment. The elderly have a lo...
journal_title:International journal of clinical practice
pub_type: 杂志文章,评审
doi:10.1111/j.1368-5031.2005.00795.x
更新日期:2006-03-01 00:00:00
abstract::This trial assessed whether a simple clinical tool can be used to stratify patients with diabetes, according to risk of developing foot ulceration. This was a prospective, observational follow-up study of 3526 patients with diabetes (91% type 2 diabetes) attending for routine diabetes care. Mean age was 64.7 (range 15...
journal_title:International journal of clinical practice
pub_type: 杂志文章
doi:10.1111/j.1368-5031.2006.00899.x
更新日期:2006-05-01 00:00:00
abstract::Aberrations in the cell cycle regulators are common features of many tumours and several have been shown to have prognostic significant in colorectal cancer. The expression patterns of cyclins D1 and E as well as cyclin-dependent kinase (CDK) inhibitors p21waf1/cip1 and p27kip1 and their interrelationship with other c...
journal_title:International journal of clinical practice
pub_type: 杂志文章
doi:10.1111/j.1742-1241.2006.01105.x
更新日期:2008-11-01 00:00:00
abstract:BACKGROUND:Ageing is intrinsically associated with a progressive decline in cardiorespiratory fitness (CRF) as measured by peak oxygen uptake (VO2peak ). Improving CRF through physical activity contribute to better and healthy ageing. High-intensity interval training (HIIT) is a potent method of improving CRF among sen...
journal_title:International journal of clinical practice
pub_type: 杂志文章,meta分析
doi:10.1111/ijcp.13490
更新日期:2020-06-01 00:00:00
abstract:BACKGROUND:Smoking is the leading risk factor for preventable morbidity and mortality as a result of heart and lung diseases and various forms of cancer. Reimbursement coverage for smoking cessation therapies remains limited in Canada and the United States despite the health and economic benefits of smoking cessation. ...
journal_title:International journal of clinical practice
pub_type: 杂志文章
doi:10.1111/ijcp.12363
更新日期:2014-05-01 00:00:00
abstract::Sexual activity is no more stressful to the heart when compared with a number of other natural daily activities, e.g. walking one mile on the level in 20 minutes. The cardiac risk of sexual activity in patients diagnosed with cardiovascular disease is minimal in properly assessed and advised patients. Erectile dysfunc...
journal_title:International journal of clinical practice
pub_type: 共识发展会议,杂志文章,评审
doi:
更新日期:2002-11-01 00:00:00
abstract::Proton pump inhibitors are highly effective acid suppressants with decades of use highlighting positive outcomes in millions of patients worldwide, and they offer minimal risk of adverse events. PPIs are considered overutilised when prescribed without an appropriate indication, when patients are left on them 'indefini...
journal_title:International journal of clinical practice
pub_type: 杂志文章,评审
doi:10.1111/j.1742-1241.2012.02921.x
更新日期:2012-06-01 00:00:00
abstract::Coronary heart disease (CHD) is the leading cause of death worldwide, and effective treatment of hyperlipidaemia can prevent development of CHD and significantly reduce the risk for cardiovascular events and mortality in this disease. The advent of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (...
journal_title:International journal of clinical practice
pub_type: 杂志文章,评审
doi:
更新日期:2001-07-01 00:00:00
abstract:BACKGROUND:Although many models have been developed to explain health behaviour, differences in individual response to symptoms remain largely unexplained; moreover, they tend to underestimate affective (i.e., emotional) processes and they neglect the construct of well-being, despite its predominant role in the definit...
journal_title:International journal of clinical practice
pub_type: 杂志文章,评审
doi:10.1111/j.1742-1241.2009.02183.x
更新日期:2009-10-01 00:00:00
abstract:OBJECTIVE:The aim of this study was to describe the occurrence, angulation and mesialisation ratio of the ectopic eruption of the maxillary permanent first molar (PFM) and its correlation with the pathological resorption of maxillary primary second molar (PSM). METHODS:This retrospective study was performed using the ...
journal_title:International journal of clinical practice
pub_type: 杂志文章
doi:10.1111/ijcp.13880
更新日期:2020-12-07 00:00:00
abstract::Lansoprazole is a proton pump inhibitor that reduces gastric acid secretion in a dose-dependent manner via inhibition of H+/K+-adenosine triphosphatase in gastric parietal cells. It also exhibits antibacterial activity against Helicobacter pylori in vitro. During almost 10 years of clinical use, lansoprazole has prove...
journal_title:International journal of clinical practice
pub_type: 杂志文章,评审
doi:
更新日期:2002-03-01 00:00:00
abstract::Using the head-up tilt test (HUTT) we evaluated 986 consecutive patients affected by unexplained syncope. In 266 patients the test induced bradycardia and/or hypotension resulting in syncope or presyncope, thus allowing a diagnosis of neurally mediated syncope. In three other patients (0.3% of the entire population an...
journal_title:International journal of clinical practice
pub_type: 杂志文章
doi:
更新日期:2003-06-01 00:00:00