diagnostic tests, routine

Chronic anal pain is diffi cult to diagnose and treat, especially with no obvious anorectal cause apparent on clinical examination. This review identifi es 3 main diagnostic
categories for chronic anal pain: local causes, functional
anorectal pain, and neuropathic pain syndromes. Conditions covered within these categories include proctalgia
fugax, levator ani syndrome, pudendal neuralgia, and coccygodynia. The signs, symptoms, relevant diagnostic tests,
and main treatments for each condition are reviewed.

Author/s:

Knowles, C. H., Cohen, R. C.

Interpreting Diagnostic Tests for SARS-CoV-2

John Bayhi — Thu, 07 May 2020 16:00:45 +0000

Date Added:

May 7, 2020

Journal/Publication:

JAMA

Publisher:

American Medical Association

Publication Date:

May 6, 2020

Pages:

[Epub ahead of print]

URL:

Interpreting Diagnostic Tests for SARS-CoV-2

Type:

Clinical Decision Aids

Format:

Article

DOI (1):

10.1001/jama.2020.8259

Keywords

COVID-19

diagnostic tests

SARS-CoV-2

2019 novel coronavirus

2019-nCOV

RT-PCR

ELISA

PMID (1):

32374370

Potentially useful information about when and how to use COVID-19 tests most effectively. James W. Mold, MD, MPH

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No abstract available.

Author/s:

Sethuraman, N, Jeremiah, SS, Ryo, A

How to Obtain a Nasopharyngeal Swab Specimen

Brian Desmarais — Sat, 18 Apr 2020 20:36:39 +0000

Date Added:

April 18, 2020

Publisher:

New England Journal of Medicine

Publication Date:

April 17, 2020

URL:

How to Obtain a Nasopharyngeal Swab Specimen

Type:

Clinical Decision Aids

Format:

Video

MeSH

COVID-19

severe acute respiratory syndrome coronavirus 2

diagnostic tests, routine

A video showing how to properly obtain a nasopharyngeal swab sample for COVID-19 testing.

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Not available.

Author/s:

Marty, F.M., Chen, K., Verrill, K.A.

Diagnosis and Management of Infectious Diarrhea

Tracy Ashby — Fri, 15 Feb 2019 06:00:00 +0000

Date Added:

February 15, 2019

Journal/Publication:

JAMA

Publisher:

American Medical Association

Publication Date:

February 14, 2019

URL:

Diagnosis and Management of Infectious Diarrhea

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2018.21974

Keywords

infectious diarrhea

stool testing

PMID (1):

30763429

MeSH

dysentery

diarrhea

diagnostic tests, routine

cause of death

anti-bacterial agents

abdominal pain

A guideline for the diagnosis and management of infectious diarrhea from the Infectious Disease Society of America.

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Infectious diarrhea is the fifth leading cause of death worldwide. In the United States, 179 million cases of acute diarrhea occur per year. Most diarrheal illnesses are self-limited and do not require evaluation or treatment beyond supportive care such as rehydration. Some infections do require antimicrobial therapy, and appropriate use of diagnostic tests and treatments may potentially minimize unnecessary costs, decrease adverse events, optimize clinical outcomes, and limit antibiotic resistance.

Author/s:

Hamilton, Keith W., Cifu, Adam S.

Clinically Diagnosing Pertussis-associated Cough in Adults and Children: CHEST Guideline and Expert Panel Report

Tracy Ashby — Mon, 11 Feb 2019 06:00:00 +0000

Date Added:

February 11, 2019

Journal/Publication:

Chest

Publisher:

American College of Chest Physicians

URL:

Clinically Diagnosing Pertussis-associated Cough in Adults and Children: CHEST Guideline and Expert Panel Report

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1016/j.chest.2018.09.027

Keywords

cough

evidence-based medicine

guidelines

infectious disease

diagnosis

PMID (1):

30321509

MeSH

diagnostic tests, routine

Pertussis is relatively common these days. Protection from the vaccine is relatively short-lived. Treatment decisions must usually be made clinically prior to the results of lab test results. This guideline provides information useful for the clinical diagnosis of pertussis in both children and adults.

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BACKGROUND:

The decision to treat a suspected case of pertussis with antibiotics is usually based on a clinical diagnosis rather than waiting for laboratory confirmation. The current guideline focuses on making the clinical diagnosis of pertussis-associated cough in adults and children.

METHODS:

The American College of Chest Physicians (CHEST) methodologic guidelines and the Grading of Recommendations, Assessment, Development, and Evaluation framework were used. The Expert Cough Panel based their recommendations on findings from a systematicreview that was recently published on the topic; final grading was reached by consensus according to Delphi methodology. The systematic review was carried out to answer the Key Clinical Question: In patients presenting with cough, how can we most accurately diagnose from clinical features alone those who have pertussis-associated cough as opposed to other causes of cough?

RESULTS:

In adults, after pre-specified meta-analysis exclusions, pooled estimates of sensitivity and specificity were generated for only 4 clinical features: paroxysmal cough, post-tussive vomiting, inspiratory whooping, and absence of fever. Both paroxysmal cough and absence of fever had high sensitivity (93.2% [95% CI, 83.2-97.4] and 81.8% [95% CI, 72.2-88.7], respectively) and low specificity (20.6% [95% CI, 14.7-28.1] and 18.8% [95% CI, 8.1-37.9]). Inspiratory whooping and posttussive vomiting had a low sensitivity (32.5% [95% CI, 24.5-41.6] and 29.8% [95% CI, 18.0-45.2]) but high specificity (77.7% [95% CI, 73.1-81.7] and 79.5% [95% CI, 69.4-86.9]). In children, after pre-specified meta-analysis exclusions, pooled estimates of sensitivity and specificity were generated for only 1 clinical feature in children (0-18 years): posttussive vomiting. Posttussive vomiting in children was only moderately sensitive (60.0% [95% CI, 40.3-77.0]) and specific (66.0% [95% CI, 52.5-77.3]).

CONCLUSIONS:

In adults with acute (< 3 weeks) or subacute (3-8 weeks) cough, the presence of whooping or posttussive vomiting should rule in a possible diagnosis of pertussis, whereas the lack of a paroxysmal cough or the presence of fever should rule it out. In children with acute (< 4 weeks) cough, posttussive vomiting is suggestive of pertussis but is much less helpful as a clinical diagnostic test. Guideline suggestions are made based upon these findings and conclusions.

Author/s:

Moore, Abigail, Harnden, Anthony, Grant, Cameron C., Patel, Sheena, Irwin, Richard S.

Interpretation of Rapid Influenza Diagnostic Test (RIDT) Results

Jeffrey Wilson — Mon, 07 Jan 2019 16:15:20 +0000

Date Added:

January 7, 2019

Publication Date:

January 7, 2019

URL:

Interpretation of Rapid Influenza Diagnostic Test (RIDT) Results

Type:

Clinical Decision Aids

Format:

Article

Keywords

flu

influenza

RIDT

rapid influenza diagnostic test

MeSH

influenza, human

influenza vaccines

diagnostic tests, routine

antigens, viral

This information on interpretation of rapid antigen tests for influenza was condensed from information on the CDC website.

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A number of factors can influence the results of RIDTs. The accuracy of RIDTs depends largely on the conditions under which they are used.

Author/s:

Mold, James, Centers for Disease Control and Prevention (CDC)

Diagnosis and Management of Nonalcoholic Liver Disease

Jeffrey Wilson — Tue, 27 Nov 2018 22:38:28 +0000

Date Added:

November 27, 2018

Journal/Publication:

JAMA

Publisher:

American Medical Association

Publication Date:

November 26, 2018

URL:

Diagnosis and Management of Nonalcoholic Liver Disease

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2018.17365

Keywords

non-alcoholic liver disease

non-alcoholic fatty liver disease

liver disease

liver cirrhosis

MeSH

non-alcoholic fatty liver disease

Hydroxymethylglutaryl-CoA Reductase Inhibitors

diagnostic tests, routine

liver cirrhosis

This is a summary of the most recent (2017) Guideline recommendations for evaluation and management of non-alcoholic live disease from the American Association for the Study of Liver Diseases (AASLD).

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MAJOR RECOMMENDATIONS

• Patients with incidental hepatic steatosis detected on imaging who lack any liver-related symptoms or signs and have normal liver biochemistries should be assessed for metabolic risk factors (eg, obesity, diabetes mellitus, dyslipidemia) and other causes of hepatic steatosis, including alcohol consumption (>14 drinks per week for women; >21 drinks per week for men) and medications.

• Routine screening for NAFLD in high-risk groups is not advised because of uncertainties surrounding diagnostic tests and treatment options, along with lack of knowledge about long-term benefits and cost-effectiveness of screening.

• The FIB-4 (age, aspartate aminotransferase, alanine aminotransferase, platelets) and NAFLD Fibrosis Score (NFS, which adds body mass index and albumin) are clinically useful tools to predict bridging fibrosis.

• Vibration-controlled transient elastography (VCTE) or magnetic resonance elastography (MRE) can noninvasively assess for advanced fibrosis.

• Weight loss generally reduces hepatic steatosis, either by hypocaloric diet alone or in conjunction with increased physical activity.

• Pharmacologic treatments should be limited to patients with biopsy-proven nonalcoholic steatohepatitis (NASH) and advanced fibrosis.

• Statins can be used to treat dyslipidemia in patients with NAFLD, NASH, and compensated NASH cirrhosis.

Author/s:

Paul, Sonali, Davis, Andrew M.