Advances in diagnostics for microbial agents: can clinical validation keep pace with the technical promises?

New technologies are revolutionizing diagnostic microbiology, but implementation of methodological advances in test evaluation has been extraordinarily slow. Published reports frequently fail to clearly distinguish between studies of analytical accuracy and those of clinical diagnostic performance. We argue that the evaluation of sensitivity and specificity, while necessary and occasionally problematic, is often inadequate to define the appropriate role of a new diagnostic test.

Impact of minimally invasive surgery on the pediatric surgical profession.

We conducted a survey among pediatric surgeons to examine the impact of the advent of minimally invasive surgery (MIS) on the pediatric surgical profession with respect to job satisfaction and training challenges. An invitation to participate in a web-based questionnaire was sent out to 306 pediatric surgeons. Apart from demographic details and training recommendations, parameters relevant to job satisfaction, including patient interaction, peer pressure, ethical considerations, academic progress, ability to train residents, and financial remuneration, were studied.

Advantages of the nested case-control design in diagnostic research.

Background: Despite its benefits, it is uncommon to apply the nested case-control design in diagnostic research. We aim to show advantages of this design for diagnostic accuracy studies.

Methods: We used data from a full cross-sectional diagnostic study comprising a cohort of 1295 consecutive patients who were selected on their suspicion of having deep vein thrombosis (DVT).

Evaluation of adrenal function using the human corticotrophin-releasing hormone test, low dose Synacthen test and 9am cortisol level in children and adolescents with central adrenal insufficiency.

Background: The insulin tolerance test (ITT) has become less popular in paediatrics because of the risks associated with hypoglycaemia. Human corticotrophin-releasing hormone (hCRH) test results correlate with the ITT and may be an acceptable method to test for central adrenal insufficiency (CAI). Simpler tests, such as the low dose Synacthen test (LDST) and 9am cortisol, have also been proposed.

Distraction from randomization in diagnostic research.

The ultimate goal of medical care, including diagnostic testing, is to improve patient outcome. Accordingly, it has been advocated widely that when establishing a test's diagnostic accuracy, the impact of the test on patient outcome subsequently must be quantified. When studying patient outcome in medical research, the use of randomized comparisons comes into perspective.

Validating and updating a prediction rule for neurological sequelae after childhood bacterial meningitis.

Recently, a prediction rule for developing neurological sequelae after childhood bacterial meningitis was developed on a small derivation set. Before implementing in practice a prediction rule must first be tested in new patients (external validation). Our aim was to study the external validity of this rule and, if necessary, to update the rule.

Genetic programming outperformed multivariable logistic regression in diagnosing pulmonary embolism.

Objective: Genetic programming is a search method that can be used to solve complex associations between large numbers of variables. It has been used, for example, for myoelectrical signal recognition, but its value for medical prediction as in diagnostic and prognostic settings, has not been documented.

Study Design And Setting: We compared genetic programming and the commonly used logistic regression technique in the development of a prediction model using empirical data from a study on diagnosis of pulmonary embolism.

Walking exercise in patients with intermittent claudication. Experience in routine clinical practice.

Background: In patients with intermittent claudication, exercise in the form of walking is effective in reducing pain and maximising achievable walking distance. However, data are lacking on the implementation of walking exercise in these patients.

Aims: To explore the current behaviour and views of patients with intermittent claudication towards taking walking exercise.