资料的评读II诊断与筛检.ppt
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1、資料的評讀(II)診斷與篩檢,神經內科 王志弘,診斷的過程,Initiation of diagnosis hypothesis初步診斷我想這病人可能有。Refinement of the diagnostic causes修正診斷他可能不是X 或 Y,但到底是何種感染呢?Narrowing the possibilitiesDefining the final diagnosis最終診斷我們應該再做個XX 切片確定,再來治療,初步診斷,目前有上萬種的診斷疾病如果我們不認識這個疾病,我們就不可能考慮到這個診斷關於疾病發生比例的文獻,讓我們了解各種診斷的可能性(pretest probabili
2、ty),修正診斷,根據Symptoms,症狀Signs,徵象Laboratory tests,實驗室檢查Imaging,影像檢查,診斷性試驗的實證,Evidence about“diagnostic tests”Is this evidence about the accuracy of diagnostic test valid?Is this(valid)evidence show that the test is useful at all?How can I apply this valid,accurate diagnostic test to a specific patient?
3、,文獻評讀,治療性Validity(closeness to the truth)Impact(size of the effect)Applicability(usefulness in our clinical practice),診斷性Is this evidence about the accuracy of diagnostic test valid?Is this(valid)evidence show that the test is useful at all?How can I apply this valid,accurate diagnostic test to a sp
4、ecific patient?,ValidUsefulApply,什麼是正常,BNP vsLV dysfunction,Is this evidence about the accuracy of a diagnostic test valid?,Validity about Diagnostic Tests,Diagnostic Test in QuestionReference(gold)standard,常見的 GOLD STANDARDS,外科或是病理標本 血液培養的菌株風溼熱,Jones CriteriaDSM IV(精神疾病)X 光長期追蹤,代表性,該檢查是否在適當的病患族群中被評
5、估過(尤其是那些在臨床上會使用此一檢查的對象)Representativecommon presentation of the target disorderconfusing presentationsinclude patients,with mild and severe,early and late,treated and untreated cases.,確定性,無論檢查結果如何,參考標準(reference standard)是否經過確認如何達到確定診斷?另一個參考標準長期追蹤確定不會延誤治療,測量,Independent and blind measurementPsychiat
6、ric disorders,Is this(valid)evidence show that the test is useful at all?,Sensitivity,Specificity,Likelihood ratios,整體盛行率,Prevalence=(a+c)/(a+b+c+d)=809/2579=31%Pre-test probability,Positive predictive value,陽性預測值=a/(a+b)=731/1001=73%檢查陽性(ferritin 65)的人當中,真正有病(缺鐵性貧血)的人的比例,Negative predictive value,陰
7、性預測值=d/(c+d)=1500/1578=95%檢查陰性(ferritin 65)的人當中,真正沒有病(缺鐵性貧血)的人的比例,Positive vs Negative Predictive Value,Pre-test probability:測前機率Post-test probability:測後機率根據前兩張slide:Positive predictive value:73%Negative predictive value:95%假設抽血檢查前病人(有病)的測前機率:50%如果陽性反應 測後機率:73%如果陰性反應 測後機率:1-95%=5%,Sensitivity,敏感度=a/
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- 资料 II 诊断
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