Patient Research Beta

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Elsevier is the world's leading publisher of Medical Information. We are proud to make available our Patient Research option as a Beta program for patients, or friends/family of patients, who have a medical need for information regarding a medical situation for them or someone they know. This Beta program provides the article you request for free, with a small handling fee, $4.95. After ordering the article and confirmation of payment, we will e-mail the document to you typically within 2 hours, but no longer than 24 hours. New methods give better estimates of changes in diagnostic accuracy when prior information is provided Journal of Clinical Epidemiology, Volume 59, Issue 3, March 2006, Pages 299-307 Abstract: ObjectiveWhether tests such as imaging should be read with or without access to prior clinical information is controversial. Naïve comparisons may suggest that the provision of prior information improves test accuracy, whereas in fact the opposite may be true. This is because provision of clinical background may actually bias test readers to over- or underinterpret relevant test findings, and they may suboptimally integrate the previous and current evidence. We propose comparing the combined accuracy of prior information and a test read (i) with or (ii) without knowledge of prior information. Analysis methods include simple decision rules and logistic regression.Study Design and SettingA study of cancer detection in women presenting with breast symptoms, in whom ultrasound could be read with or without reviewing prior mammography.ResultsNaïve analysis gave an area under the receiver operating characteristics curve (AUC) for ultrasound read with mammography on view that was 4.6% higher (P < .01) than without mammography on view. Our approach, comparing the combined accuracy of mammography and ultrasound read i) with and ii) without knowledge of mammographic findings, showed much smaller differences.ConclusionOur approach is more appropriate than naïve analyses. The particular choice of analytic method depends on the study size and the diagnostic accuracy of combinations of the prior information and the test reading. This Beta program is not intended for use by Medical Professionals. To obtain this document through the Patient Research option you must have a medical need, only use the document for personal use, and agree to all the terms and conditions below. Also, these articles can be obtained for free at your local public or university hospital library. We encourage you to use this as a means of obtaining articles of interest to you. 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