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Kuhn Josepha van den Berg Pieter Mamede Silvia Zwaan Laura Bindels Patrick van Gog Tamara 《Advances in health sciences education : theory and practice》2022,27(1):189-200
Advances in Health Sciences Education - When physicians do not estimate their diagnostic accuracy correctly, i.e. show inaccurate diagnostic calibration, diagnostic errors or overtesting can occur.... 相似文献
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Markus Sellmayr Moritz Roman Hernandez Petzsche Qiuyue Ma Nils Krüger Helen Liapis Andreas Brink Barbara Lenz Maria Lucia Angelotti Viviane Gnemmi Christoph Kuppe Hyojin Kim Eric Moniqu Johannes Bindels Ferenc Tajti Julio Saez-Rodriguez Maciej Lech Rafael Kramann Paola Romagnani Hans-Joachim Anders Stefanie Steiger 《Journal of the American Society of Nephrology : JASN》2020,31(12):2773
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Yvette van Ierland Gijs Elshout Marjolein Y Berger Yvonne Vergouwe Marcel de Wilde Johan van der Lei Henri?tte A Mol Rianne Oostenbrink 《The British journal of general practice》2015,65(633):e224-e233
BackgroundClinical prediction rules (CPRs) to identify children with serious infections lack validation in low-prevalence populations, which hampers their implementation in primary care practice.AimTo evaluate the diagnostic value of published CPRs for febrile children in primary care.MethodAlarm signs of serious infection and clinical management were extracted from routine clinical practice data and manually recoded with a structured electronic data-entry program. Eight CPRs were selected from literature. CPR-variables were matched with alarm signs and CPRs were applied to the GPC-population. ‘Referral to emergency department (ED)’ was used as a proxy outcome measure for ‘serious infection’. CPR performance was assessed by calibration analyses, sensitivity, specificity, and area under the ROC-curve (ROC-area).ResultsA total of 9794 GPC-contacts were eligible, 54% male, median age 2.3 years (interquartile range 1.0–4.6 years) and 8.1% referred to ED. Frequencies of CPR-variables varied from 0.5% (cyanosis, drowsy) to 25% (temperature ≥40°C). Alarm signs frequently included in CPRs were ‘ill appearance’, ‘inconsolable’, and ‘abnormal circulatory or respiratory signs’. The height of the CPR’s predicted risks generally corresponded with being (or not being) referred to the ED in practice. However, calibration-slopes indicated that three CPRs underestimated the risk of serious infection in the GPC-population. Sensitivities ranged from 42% to 54%, specificities from 68% to 89%. ROC-areas ranged from 0.52 to 0.81, with best performance of CPRs for children aged <3 months.ConclusionPublished CPRs performed moderately well in the primary out-of-hours care population. Advice is given on how to improve translation of CPRs to primary care practice. 相似文献
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Xiao Yang Yim Karen Zhang Hong Bakker Diane Nederlof Rianne Smeitink Jan A. M. Renkema Herma Hollmann Markus W. Weber Nina C. Zuurbier Coert J. 《Cardiovascular drugs and therapy / sponsored by the International Society of Cardiovascular Pharmacotherapy》2021,35(4):745-758
Cardiovascular Drugs and Therapy - Sonlicromanol is a phase IIB clinical stage compound developed for treatment of mitochondrial diseases. Its active component, KH176m, functions as an antioxidant,... 相似文献
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BACKGROUND: To elucidate whether patients with a septic shock develop pulmonary edema in a treatment protocol in which volume loading is guided by its effect on the cardiac output, rather than by preset values of pulmonary artery wedge pressure (PAWP). METHODS: 15 consecutive patients with the diagnosis of septic shock were studied in a prospective observational study. Cardiac output, PAWP and extravascular lung water index (EVLWI) were determined at regular intervals during the first 24 h of treatment. Fluid challenges were given if MAP was <80 mm Hg and/or CI was <4.5 l/min/m(2), and PAWP was <16 mm Hg. Further fluid challenges were only given if the preceding fluid challenge resulted in an increase in CI of more than 10% and PAWP was still <16 mm Hg. RESULTS: EVLWI was slightly above normal (10.4+/-1.2 ml/kg) and did not change during the treatment protocol. One third of the patients had an initial PAWP>16 mmHg. In these patients, EVLWI was significantly higher than in patients with an initial PAWP <16 mm Hg (14.1+/-1.1 ml/kg versus 10.0+/-0.9 ml/kg, P=0.026). No significant correlation was found between PAWP and EVLWI. CONCLUSION: In this study, patients with septic shock did not develop pulmonary edema during the first 24 h of treatment, when their fluid regimen was guided by the effects on cardiac output. 相似文献
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