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PubMed1998

Effect of HIV reporting by name on use of HIV testing in publicly funded counseling and testing programs.

CONTEXT: Policies requiring confidential reporting by name to state health departments of persons infected with the human immunodeficiency virus (HIV) have potential to cause some of them to avoid HIV testing. OBJECTIVE: To describe trends in use of HIV testing services at publicly funded HIV counseling and testing sites before and after the implementation of HIV reporting policies. DESIGN AND SETTING: Analysis of service provision data from 6 state health departments (Louisiana, Michigan, Nebraska, Nevada, New Jersey, and Tennessee) 12 months before and 12 months after HIV reporting was introduced. MAIN OUTCOME MEASURE: Percent change in numbers of persons tested at publicly funded HIV counseling and testing sites after implementation of confidential HIV reporting by risk group. RESULTS: No significant declines in the total number of HIV tests provided at counseling and testing sites in the months immediately after implementation of HIV reporting occurred in any state, other than those expected from trends present before HIV reporting. Increases occurred in Nebraska (15.8%), Nevada (48.4%), New Jersey (21.3%), and Tennessee (62.8%). Predicted decreases occurred in Louisiana (10.5%) and Michigan (2.0%). In all areas, testing of at-risk heterosexuals increased in the year after HIV reporting was implemented (Louisiana, 10.5%; Michigan, 225.1 %; Nebraska, 5.7%; Nevada, 303.3%; New Jersey, 462.9%; Tennessee, 603.8%). Declines in testing occurred among men who have sex with men in Louisiana (4.3%) and Tennessee (4.1%) after HIV reporting; testing increased for this group in Michigan (5.3%), Nebraska (19.6%), Nevada (12.5%), and New Jersey (22.4%). Among injection drug users, testing declined in Louisiana (15%), Michigan (34.3%), and New Jersey (0.6%) and increased in Nebraska (1.7%), Nevada (18.9%), and Tennessee (16.6%). CONCLUSIONS: Confidential HIV reporting by name did not appear to affect use of HIV testing in publicly funded counseling and testing programs.

AIDS Serodiagnosis↗

PubMed2005

The performance of tests of publication bias and other sample size effects in systematic reviews of diagnostic test accuracy was assessed.

BACKGROUND AND OBJECTIVE: Publication bias and other sample size effects are issues for meta-analyses of test accuracy, as for randomized trials. We investigate limitations of standard funnel plots and tests when applied to meta-analyses of test accuracy and look for improved methods. METHODS: Type I and type II error rates for existing and alternative tests of sample size effects were estimated and compared in simulated meta-analyses of test accuracy. RESULTS: Type I error rates for the Begg, Egger, and Macaskill tests are inflated for typical diagnostic odds ratios (DOR), when disease prevalence differs from 50% and when thresholds favor sensitivity over specificity or vice versa. Regression and correlation tests based on functions of effective sample size are valid, if occasionally conservative, tests for sample size effects. Empirical evidence suggests that they have adequate power to be useful tests. When DORs are heterogeneous, however, all tests of funnel plot asymmetry have low power. CONCLUSION: Existing tests that use standard errors of odds ratios are likely to be seriously misleading if applied to meta-analyses of test accuracy. The effective sample size funnel plot and associated regression test of asymmetry should be used to detect publication bias and other sample size related effects.

Diagnostic Errors↗

PubMed2006

Comparison of 20-minute pad test versus 1-hour pad test in women with stress urinary incontinence.

OBJECTIVES: To compare the sensitivity of the 20-minute pad test with that of the 1-hour pad test in women with stress urinary incontinence. METHODS: From January to March 2005, 100 women with stress urinary incontinence who underwent a urodynamic study were enrolled. Each patient underwent a 1-hour pad test before the urodynamic study. The infusion of 250 mL water into the bladder in the 20-minute pad test was performed after the urodynamic study. The results of the two tests in each patient were analyzed and compared using Pearson's chi-square or the Wilcoxon signed-rank test. RESULTS: The mean age of the 100 women was 53.3 +/- 12.1 years, with a mean parity of 2.9 +/- 1.5. In the 100 patients, the 20-minute pad test had better sensitivity than the 1-hour pad test (46% versus 34%, P <0.001). In the quantitative study, the two pad tests had fair agreement, and the pad weight results for the 1-hour pad test had significantly larger amounts than those for the 20-minute pad test (P = 0.002). CONCLUSIONS: The 20-minute pad test had better sensitivity than the 1-hour pad test in women with stress urinary incontinence.

Adult↗

PubMed2001

A comparative meta-analysis on the variability in test performance among FDA-licensed enzyme immunosorbent assays for HIV antibody testing.

BACKGROUND: Although independently published studies have compared diagnostic test performance among various manufactured enzyme immunosorbent assays (EIAs) used in HIV antibody testing, none have attempted to formally synthesize such results through a comparative meta-analysis. In particular, no estimates of post-FDA approval test performance, in terms of sensitivity and specificity, and their associated variability within each manufacturer, has been reported in the literature, along with an analysis of the relative differences in manufacturer test performance in practice (after FDA approval). METHODS: Retrieval of studies was done using several searching strategies, while retrieval of manufacturer information was done through package inserts and direct contacts. Comparisons of HIV antibody test performance across manufacturers and within a single manufacturer were made based on 16 estimates (from 11 articles) and 33 estimates (from 19 articles), respectively. A generalized linear model, based upon Bayes estimates of sensitivity and specificity, was used to assess the impact of several study-level covariates on the performance of these EIAs, with overall estimates of manufacturer test performance and associated variability obtained based on generalized estimating equations. RESULTS: Estimates of test performance were obtained across studies, with a significant (P < 0.01) difference between manufacturers. The test performance of each manufacturer significantly interacted (P < 0.05) with the following study-level covariates: type of population screened, year of diagnostic testing and study quality. Among a single manufacturer, Abbott, significant improvement in estimates of test sensitivity (P < 0.01) and specificity (P < 0.01) was observed with each newly produced antibody kit. CONCLUSION: Estimates on the relative differences in test performance within each manufacturer may be used for guiding decisions on the choice of EIA test kit for HIV antibodies, given the type of population screened, as well as cost and time considerations. In addition, the results of this meta-analysis may be used in modeling HIV prevalence when used as prior information within a Bayesian framework or for standardizing test results among various manufacturers.

Bayes Theorem↗

PubMed2003

Promoting HIV testing among never-tested Hispanic men: a doctor's recommendation may suffice.

This study examined factors associated with HIV testing intentions among a community sample of 255 never-tested Hispanic men. It compared (1) men who intended to test in the next 6 months with those who did not and (2) men who intended to test only on the day of the interview with those who intended to test in the next 6 months. Eighty-four percent of men had never been offered testing. Yet, 86% would accept testing if recommended by their doctor. The strongest multivariate predictor of testing intention was willingness to accept a physician-endorsed test. Almost 49% of men who intended to test in the next 6 months would only do so if the test were offered on the interview day. These findings highlight the importance of encouraging physicians, particularly in high-prevalence areas, to routinely recommend testing. They also suggest that for some men, there is a window of opportunity for testing that does not endure.

Adult↗

PubMed1984

[Improved metabolic state in insulin-tested diabetes. Self-testing of blood or urine glucose on 2 days per week].

Randomized serial tests of their metabolic state over four weeks, without self-testing and during daily urinary glucose-profile testing (4 tests) with the Diabur-Test or blood-glucose levels with the Haemo-Gluco-test 20-800 (5 tests daily) on two days weekly were undertaken on 27 unselected insulin-treated outpatient diabetes. HbA1, blood glucose, serum cholesterol, triglycerides and VLDL, LDL and HDL cholesterol were the target values. The following metabolic values were significantly reduced (P less than 0.05) during blood-glucose self-testing, compared with the results during the non-testing phase: HbA1 on average by 11%, blood-glucose (starving) by 20%, serum cholesterol by 9%, serum triglycerides by 13%. Self-testing of urinary glucose (compared with the test-free phase) brought little improvement in the metabolic state. The results of self-testing were the more impressive the worse the metabolic state during the phase without self-testing. Except for VLDL and HDL cholesterol, changes in HbA1 correlated well during all phases with changes in the other metabolic values (P less than 0.05).

Adolescent↗

PubMed2006

Approaching the CDC's guidelines on the HIV testing of inpatients: physician-referral versus nonreferral-based testing.

Despite ongoing evidence that one quarter of HIV-infected people in the United States are unaware of their infection, widespread implementation of the Centers for Disease Control and Prevention's 1993 recommendations regarding routine inpatient HIV testing has not occurred. This study compares two HIV testing strategies: the initial phase of inpatient HIV testing (1999-2001) utilized a physician-referral-based system. The second phase (2001-2003) included the first 2 years' experience with having trained HIV counselors directly approach inpatients regarding their willingness to undergo voluntary HIV counseling and testing (VCT) without physician referral. This latter phase was prompted by a patient attitude survey demonstrating favorable responses to unsolicited approaches by staff regarding HIV testing. Barriers to implementing the latter strategy are discussed and initial experience with rapid HIV testing on this service is also presented. Referral-based testing yielded 2.3 patient referrals (6.4% of total admissions) resulting in 1.2 HIV tests and 0.7 counseling only sessions per day. Nonreferral based testing resulted 6.2 HIV tests and another 3.0 counseling-only sessions per day. HIV VCT on an inpatient service is feasible but challenging. Most patients respond favorably to being approached for VCT. Routinely offering HIV tests to inpatients yields higher testing rates than physician referral-based systems and increases the number of patients who know their HIV status. Recommendations for implementing routing HIV testing on an inpatient service are made.

AIDS Serodiagnosis↗

PubMed1990

Interrater and test-retest reliability of two pediatric balance tests.

The purpose of this study was to examine the interrater and test-retest reliability of a one-leg balance test and a tiltboard balance test. Twenty-four normally developing children aged 4 through 9 years participated in the study. Time and quality of balance on one leg and degrees of tilt on a tiltboard prior to postural adjustment were measured. Both tests were completed with eyes open and with eyes closed. Interrater reliability was examined using two raters. Test-retest reliability, with a one-week interval between test and retest, was examined for a subgroup consisting of 12 children. Spearman rank-order correlation coefficients were used as indexes of both interrater and test-retest reliability for time and degrees of tilt. To supplement the correlation coefficients, the magnitudes of difference between raters' scores and between test and retest scores were calculated. Spearman coefficients were moderate to high for one-leg balance when scores for both feet were combined for both eyes-open and eyes-closed conditions. The magnitude of difference between scores was low, indicating good agreement between raters and across time. Interrater and test-retest reliabilities of quality of one-leg standing balance were examined by calculating percentages of agreement and Cohen's Kappa statistics. Results of these analyses revealed the need for further study. The Spearman coefficients for the interrater tiltboard test were high; however, the test-retest coefficients were low. The magnitudes of difference between scores were small for the two raters, but large for test and retest. These results are important to consider when using these tests for initial evaluation or for monitoring patient progress.

Biomechanical Phenomena↗

PubMed1995

A test to measure lift capacity of physically impaired adults. Part 1--Development and reliability testing.

STUDY DESIGN: Two laboratory studies and one field study evaluated the safety and test-retest reliability of a new test of lift capacity. The first two studies were conducted in a carefully controlled laboratory setting. The first study investigated the safety and intra-rater reliability of the EPIC Lift Capacity test protocol with healthy adult subjects. The second study assessed the safety and inter-rater reliability of the test with disabled subjects. The third study was conducted in the field with 65 evaluators and investigated the safety and intra-rater reliability of the test with healthy adult subjects. OBJECTIVE: To assess the safety and reliability of a new test of lift capacity. SUMMARY OF BACKGROUND DATA: A new test of lift capacity has been developed. Test development occurred within the context of ergonomic standards and guide-lines of the major professional associations and public agencies that govern test development in the United States. METHODS: In study no. 1, 26 healthy subjects participated. In study no. 2, 14 disabled subjects participated. In study no. 3, 318 healthy subjects participated. After subjects underwent basic screening and warm-up, the EPIC Lift Capacity test was administered. One to 2 weeks later, the test was administered again. Correlations between the times of testing were calculated. RESULTS: No subjects were injured. Hamstring soreness the next day that resolved without complication was reported by some healthy subjects. None of the disabled subjects reported new symptoms. CONCLUSION: The safety and reliability of the EPIC Lift Capacity test was adequately demonstrated in a laboratory setting and across multiple field sites with evaluators who have varying types and degrees of professional preparation.

Adult↗

PubMed2005

Predictors of HIV testing and intention to test among Hispanic farmworkers in South Florida.

CONTEXT AND PURPOSE: This study examined the predictors of HIV testing and factors associated with intention to accept a free HIV test among 244 Hispanic migrant/seasonal farmworkers in South Florida. METHODS: Time and space sampling procedures were used to recruit participants in public venues. Bilingual staff interviewed eligible respondents in these settings. FINDINGS: Despite high rates of sexual risk, only 21% of respondents had been tested for HIV. The majority of those tested were females tested during prenatal care. In multivariable logistic regression analyses, being female (odds ratio [OR] = 3.73), having at least 12 years of education (OR = 4.46), earning more than $201 per week (OR = 2.76), and ever having used marijuana (OR = 3.31) were positively associated with having been tested for HIV, while not being documented (OR = 0.24) and having rated one's health as "very good" or "good" (OR = 0.42) were negatively associated with testing. The multivariable predictors of intention to accept a free HIV test were having visited a health care provider and/or an emergency room in the past 12 months (OR = 1.97), having been tested for HIV (OR = 2.36), preferring an HIV test that used a finger stick for specimen collection with results given in 30 minutes (OR = 4.47), and worrying "some" or "a lot" about getting HIV (OR = 3.64). Women (OR = 0.52) were less likely than men to intend to accept a free HIV test. CONCLUSIONS: Our findings highlight the importance of routinely offering HIV testing to sexually active individuals in high HIV prevalence areas. They also suggest the need to make testing more accessible to migrant and seasonal farmworkers.

Adult↗

PubMed1998

Uptake and acceptability of antenatal HIV testing: randomised controlled trial of different methods of offering the test.

OBJECTIVE: To determine the uptake and acceptability of different methods of a universal offer of voluntary HIV testing to pregnant women. DESIGN: Randomised controlled trial involving four combinations of written and verbal communication, followed by the direct offer of a test. The control group received no information and no direct offer of a test, although testing was available on request. SETTING: Hospital antenatal clinic covering most of the population of the city of Edinburgh. SUBJECTS: 3024 pregnant women booking at the clinic over a 10 month period. MAIN OUTCOME MEASURES: Uptake of HIV testing and women's knowledge, satisfaction, and anxiety. RESULTS: Uptake rates were 6% for those in the control group and 35% for those directly offered the test. Neither the style of leaflet nor the length of discussion had an effect on uptake. Significant independent predictors of uptake were a direct test offer; the midwife seen; and being unmarried, previously tested, and younger age. Knowledge of the specific benefits of testing increased with the amount of information given, but neither satisfaction nor anxiety was affected by the type of offer. CONCLUSIONS: The universal offer of HIV testing is not intrusive and is acceptable to pregnant women. A policy of offering the HIV test to all women resulted in higher uptake and did not increase anxiety or dissatisfaction. Uptake depends more on the midwife than the method of offering the test. Low uptake rates and inadequate detection of HIV infection point to the need to assess a more routine approach to testing.

Adult↗

PubMed2004

HIV testing and receipt of test results among homeless persons with serious mental illness.

OBJECTIVE: The purpose of this study was to determine the rates and predictors of HIV testing and receipt of results among homeless adults with serious mental illness in the initial 3-month period after contact with a community-based case management program. METHOD: Baseline and follow-up interview data came from clients (N=5,890) in the Access to Community Care and Effective Services and Supports program, an 18-site, 5-year federally sponsored demonstration designed to evaluate the effect of service system integration on outcomes for homeless persons with serious mental illness. RESULTS: Overall, 38.0% of clients were tested for HIV in the 3 months after program entry; of these, 88.8% returned to receive their test results. Likelihood of being tested was independently associated with having been tested before, more severe psychiatric symptoms and drug problems, level of worry about getting AIDS, younger age, less education, minority status, longer-term homelessness, being sexually assaulted, being arrested, and health services utilization. Among those tested, likelihood of receiving the test results was higher among those with a history of prior testing and return for results, a higher frequency of testing, and more years of education and lower among those with drug abuse problems, outpatient medical service utilization, disability, and sexually transmitted disease. Interaction analyses showed that, for men, greater social support increased the likelihood of both HIV testing and receipt of results, while sexual victimization during follow-up decreased the likelihood that men would return for their HIV results. CONCLUSIONS: The majority of homeless clients enrolled in an intensive case management program were not tested for HIV during the 3-month period after program entry. Among those tested, however, nearly 90% reported receiving their results. The findings may enhance the development and targeting of strategies to increase testing and awareness of HIV serostatus among high-risk mentally ill homeless persons.

AIDS Serodiagnosis↗

PubMed2005

The resisted supination external rotation test: a new test for the diagnosis of superior labral anterior posterior lesions.

PURPOSE: To evaluate a new clinical test, the resisted supination external rotation test, for the diagnosis of superior labral anterior posterior lesions of the shoulder. STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 2. METHODS: Forty athletes (average age, 23.9 years) with activity-related shoulder pain were enrolled in the study. The patients underwent 3 different tests designed specifically to detect superior labral anterior posterior lesions (the resisted supination external rotation test, the crank test, and the active compression test); the tests were performed in a random order on the affected shoulder. The results of the tests were compared with arthroscopic findings. RESULTS: Out of 40 athletes, 29 (72.5%) had superior labral anterior posterior tears. The resisted supination external rotation test had the highest sensitivity (82.8%), specificity (81.8%), positive predictive value (92.3%), negative predictive value (64.3%), and diagnostic accuracy (82.5%) of all tests performed. CONCLUSION: By re-creating the peel-back mechanism, the resisted supination external rotation test is more accurate than 2 other commonly used physical examination tests designed to diagnose superior labral anterior posterior tears in overhead-throwing athletes. By using this test in the context of a thorough clinical history and physical examination, lesions of the superior labrum can be more reliably diagnosed.

Acromioclavicular Joint↗

PubMedDate not supplied

Which is more useful, the "full can test" or the "empty can test," in detecting the torn supraspinatus tendon?

The purpose of this study was to determine the clinical usefulness of the full can and empty can tests for determining the presence of a torn supraspinatus tendon. The two tests were performed in 143 shoulders of 136 consecutive patients. In each test, the muscle strength was determined by manual muscle testing, and the presence of pain during the maneuver was recorded. We interpreted the tests as positive when there was 1) pain, 2) muscle weakness, or 3) pain or muscle weakness or both. Shoulders were examined by high-resolution magnetic resonance imaging with 95% accuracy for full-thickness rotator cuff tears. There were 35 shoulders with full-thickness tears of the supraspinatus tendon. The accuracy of the tests was the greatest when muscle weakness was interpreted as indicating a torn supraspinatus tendon in both the full can test (75% accurate) and the empty can test (70% accurate). However, there was no significant difference between the accuracy of the tests when this criterion was used. Pain was observed in 62 shoulders (43%) during the full can test and in 71 shoulders (50%) during the empty can test, but the difference was not statistically significant. Muscle weakness should be interpreted as indicative of supraspinatus tendon tear. Using this indicator, both tests are equivalent in terms of accuracy, but considering pain provocation, the full can test may be more beneficial in the clinical setting.

Adolescent↗

PubMed2005

Diagnostic accuracy of a new clinical test (the Thessaly test) for early detection of meniscal tears.

BACKGROUND: Clinical tests used for the detection of meniscal tears in the knee do not present acceptable diagnostic sensitivity and specificity values. Diagnostic accuracy is improved by arthroscopic evaluation or magnetic resonance imaging studies. The objective of this study was to evaluate the diagnostic accuracy of a new dynamic clinical examination test for the detection of meniscal tears. METHODS: Two hundred and thirteen symptomatic patients with knee injuries who were examined clinically, had magnetic resonance imaging studies performed, and underwent arthroscopic surgery and 197 asymptomatic volunteers who were examined clinically and had magnetic resonance imaging studies done of their normal knees were included in this study. For clinical examination, the medial and lateral joint-line tenderness test, the McMurray test, the Apley compression and distraction test, the Thessaly test at 5 degrees of knee flexion, and the Thessaly test at 20 degrees of knee flexion were used. For all clinical tests, the sensitivity, specificity, false-positive, false-negative, and diagnostic accuracy rates were calculated and compared with the arthroscopic and magnetic resonance imaging data for the test subjects and the magnetic resonance imaging data for the control population. RESULTS: The Thessaly test at 20 degrees of knee flexion had a high diagnostic accuracy rate of 94% in the detection of tears of the medial meniscus and 96% in the detection of tears of the lateral meniscus, and it had a low rate of false-positive and false-negative recordings. Other traditional clinical examination tests, with the exception of joint-line tenderness, which presented a diagnostic accuracy rate of 89% in the detection of lateral meniscal tears, showed inferior rates. CONCLUSIONS: The Thessaly test at 20 degrees of knee flexion can be used effectively as a first-line clinical screening test for meniscal tears, reducing the need for and the cost of modern magnetic resonance imaging methods.

Adolescent↗

PubMed2005

New combination test for hepatitis C virus genotype and viral load determination using Amplicor GT HCV MONITOR test v2.0.

AIM: To develop a new sensitive and inexpensive hepatitis C virus (HCV) combination test (HCV Guideline test) that enables the determination of HCV genotypes 1, 2 and 3, and simultaneous determination of HCV viral load using commercial Amplicor GT HCV MONITOR test v2.0 (microwell version). METHODS: The HCV Guideline test used the PCR product generated in commercial Amplicor GT HCV Monitor test v2.0 for viral load measurement using microwell plate version of Amplicor HCV Monitor and also captured on separate plates containing capture probes and competitive oligonucleotide probes specific for HCV genotypes 1, 2 and 3, The HCV genotype was subsequently determined using the biotin-labeled PCR product and five biotin-labeled HCV-specific probes. RESULTS: The sensitivity of the HCV Guideline test was 0.5 KIU/mL. Specificity of the HCV Guideline test was confirmed by direct sequencing of HCV core region and molecular evolutionary analyses based on a panel of 31 samples. The comparison of the HCV Guideline test and an in-house HCV core genotyping assay using 252 samples from chronic hepatitis C patients indicated concordant results for 97.2% of samples (59.5% genotype 1, 33.7% genotype 2, 6.0% genotype 3, and 0.8% mixed genotypes). Similarly, the HCV Guideline test showed concordance with a serological test, and the serological test failed to assign any serotype in 12.7% of the samples, indicating a better sensitivity of the HCV Guideline test. CONCLUSION: Clinically, both viral load and genotypes (1, 2 and 3) have been found to be major predictors of antiviral therapy outcome regarding chronic hepatitis C based on guidelines and they are, in normal circumstances, performed as separate stand-alone assays. The HCV Guideline test is a useful method for screening large cohorts in a routine clinical setting for determining the treatment regimen and for predicting the outcome of antiviral therapy of chronic hepatitis C.

Evolution, Molecular↗

PubMed1992

Evaluation of syncope by upright tilt testing with isoproterenol. A nonspecific test.

OBJECTIVE: To determine the proportion of patients with syncope of unknown etiology who have a positive response to upright tilt testing and to determine the specificity of this test as a marker for vasodepressor syncope. DESIGN: Comparison of upright tilt testing with isoproterenol in patients with syncope of unknown etiology and in controls. SETTING: Outpatient clinics of a tertiary care center. PATIENTS: A total of 20 patients with syncope of unknown etiology and 40 controls matched by age, sex, and lack of underlying cardiovascular or other diseases had upright tilt testing with isoproterenol infusion. Controls consisted of two groups (groups I and II) who had slightly different methods of tilt testing in conjunction with isoproterenol. INTERVENTIONS: Upright tilt testing at 80 degrees from horizontal was done for up to 15 minutes. If end points were not reached, infusion of isoproterenol was started at 1 microgram/min and increased with graded increments in infusion rates up to 5 micrograms/min. MEASUREMENTS: The development of syncope or presyncope in association with hypotension, bradycardia, or both. MAIN RESULTS: Positive response to tilt testing in patients with syncope was 75% (95% CI, 55% to 95%); it was 65% in control group I (CK, 44% to 86%) and 45% in control group II (CI, 20% to 70%). Case patients and controls with positive tilt-test responses were similar with respect to time to completion of the test, mean total isoproterenol dose, mean isoproterenol dose level at completion, average mean blood pressure at completion, mean heart rate at completion, mean decline in systolic blood pressure, and decline in mean blood pressure or heart rate (P greater than 0.05 for all comparisons). Further, symptoms during tilt testing in case patients with positive responses were similar to those in controls with positive tilt-test results. CONCLUSIONS: The rate of positive tilt testing in patients with syncope is equivalent to that in controls without a history of syncope. The low specificity of this test makes its use as a marker for vasodepressor syncope questionable.

Adolescent↗

PubMed1992

Reassessment of preoperative laboratory testing has changed the test-ordering patterns of physicians.

To test the hypothesis that physicians have substantially reduced the ordering of unwarranted preoperative tests, the authors reviewed 2,093 medical records of patients having four surgical procedures performed at three institutions in three cities in 1979, 1981, 1983, 1985 or 1987. Excluding hemoglobin measurements, the incidence of ordering preoperative laboratory tests unwarranted by findings on history or physical examination decreased from 32.2 to 25.9 percent during this decade, representing a 19.6 percent reduction. This decrease was irregular and varied from operation to operation, test to test and institution to institution. Overall, the percentage of preoperative tests ordered that were unwarranted decreased from 66.9 percent in 1979 to 60.1 percent in 1987. Extrapolating these results, the authors estimate that more than $320 million was saved annually by elimination of unwarranted tests and that the potential savings could exceed $1.35 billion a year. Unexpectedly, the preoperative ordering of medically indicated tests also decreased (from 92.9 to 80.9 percent, representing a 12.9 percent reduction). Because the benefit of performing justified tests is probably greater than the benefit of avoiding unwarranted tests, the net change has probably not been beneficial. A better system for obtaining justified tests and for eliminating the unwarranted tests may be necessary before a net benefit occurs. Punitive measures to reduce testing without prior establishment of such a system may save money, but impair health.

Chicago↗