[Trends of cardiovascular disease in Italy].
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Adult↗
Biomedical subjects
Federico Vancheri
Publications and source records attributed to Federico Vancheri.
Is clinical diagnosis of heart failure reliable?-Clinical judgement of cardiologists versus internists.
BACKGROUND: Heart failure is a major cause of morbidity and mortality. Its diagnosis is mainly clinical. Most patients are seen by cardiologists and internists. However, it is not known whether clinical practices vary by specialty. We sought to evaluate the concordance in the clinical judgement of heart failure between cardiologists and internists. METHODS: Clinical judgement was investigated in 17 cardiologists and 25 internists from four district hospitals using the probability assessment of heart failure diagnosis in 30 case histories based on real patients. Use of clinical information in the diagnostic assessment was defined by the regression coefficients of multiple regression analysis, in which the diagnostic probability was the dependent variable and the clinical criteria the independent variables. The importance attributed to clinical variables, as reported by doctors in a questionnaire, and that of clinical practice, as expressed by the magnitude of the regression coefficients, were compared. RESULTS: We found no significant difference between cardiologists and internists. However, within each group of specialists, there was a wide inter-observer variation in the probability assessment of heart failure in the same case histories. The probability ranged from 25.6 to 83%. The relative importance of clinical variables actually used in diagnostic assessment was different from that reported by doctors. CONCLUSIONS: Cardiologists and internists do not differ in their clinical judgement of heart failure. However, within each group there can be wide discrepancies in the evaluation of the same case histories. This may be related to the different use of clinical information, as indicated by the wide confidence intervals of regression coefficients for clinical criteria. The way doctors use clinical information in practice differs from how they think they use it.
Journal Article↗
[Does this patient have hypertension? Different methodologies in the measurement of arterial pressure].
Recommendations on the techniques for the measurement of hypertension have been published by WHO and the International Society of Hypertension. In order to assess the impact of these recommendations on the clinical practice among physicians, we have conducted a survey using a self reported questionnaire, among 211 hospital internists, 51 hospital cardiologists and 153 general practitioners (GPs). Large differences in the technique for the measurement of blood pressure were recorded within each group of specialists, whereas internists, cardiologists and GPs did not differ as groups. About half of the internists and cardiologists, and about two thirds of GPs reported they usually record the diastolic blood pressure at the fourth Korotkoff phase, while the others use the fifth phase. There was also disagreement on the patient position, sitting or lying, during blood pressure measurement. Physicians dealing with diagnosis and treatment of hypertension do not follow the international Society guidelines. Such differences may partly explain the inadequate control of hypertension in the general population and the increase in the prevalence of heart failure.
Adult↗
[Subclinical thyroid diseases].
The term "subclinical thyroid diseases" describes conditions characterized by low or elevated thyroid-stimulating hormone (TSH), normal levels of circulating thyroid hormones (thyroxine and triiodothyronine), and few or no definite clinical signs or symptoms of thyroid dysfunction. Therefore, it is a diagnosis based on laboratory evaluation, not on clinical criteria. Because the risk of subclinical thyroid disease increases with age, the number of cases should increase as population ages. Their importance lies in the possible adverse effects on the heart, lipids, bone mineral density, quality of life and mortality. Although the subclinical thyroid diseases tend to progress to overt disease, TSH levels in some subjects return to the reference range. However there is controversy about the definition, clinical importance, consequences of untreated disease, whom to screen and when to initiate treatment. We reviewed the literature and our recommendations about screening and treatment are based upon the existing evidence and the author's experience.
Humans↗