Diagnostic Accuracy of History Taking and Physical Examination for Assessing Anterior Cruciate Ligament Lesions of the Knee in Primary Care.
Arch Phys Med Rehabil. 2010 Sep;91(9):1452-1459
Authors: Wagemakers HP, Luijsterburg PA, Boks SS, Heintjes EM, Berger MY, Verhaar JA, Koes BW, Bierma-Zeinstra SM
Wagemakers HP, Luijsterburg PA, Boks SS, Heintjes EM, Berger MY, Verhaar JA, Koes BK, Bierma-Zeinstra SM. Diagnostic accuracy of history taking and physical examination for assessing anterior cruciate ligament lesions of the knee in primary care. OBJECTIVE: To assess the diagnostic accuracy of history taking and physical examination for assessing anterior cruciate ligament (ACL) lesions in primary care. DESIGN: Cross-sectional diagnostic study. SETTING: Primary care. PARTICIPANTS: Patients (N=134; age, 18-65y) who consulted their general practitioner (GP) within 5 weeks after injury. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Index tests were obtained with a questionnaire and physical examination. Magnetic resonance imaging (MRI) was used as the reference test. Logistic regression analysis was used to determine associations with ACL lesions. Diagnostic accuracy was determined by calculating sensitivity (Se), specificity (Sp), predictive values, and likelihood ratio (LR). RESULTS: MRI showed an ACL lesion in 28 of 134 included patients. “Effusion,” “popping sensation,” “giving way,” and “anterior drawer test (ADT)” showed associations with an ACL lesion (P< .05). Popping sensation showed Se, Sp, positive predictive value (PPV), and positive LR (LR(+)) of .63, .73, .39, and 2.3, respectively. Combining determinants from history taking (2 of 3 positive results regarding effusion, popping sensation, and giving way) improved diagnostic accuracy (Se, .71; Sp, .71; PPV, .42; and LR(+), 2.5). The ADT added diagnostic accuracy to these combinations (Se, .63; Sp, .85; PPV, .52; and LR(+), 4.2). CONCLUSIONS: ACL lesions are seen frequently. Based on history taking (effusion, popping sensation, and/or giving way) and physical examination (ADT), GPs can screen for ACL lesions in primary care.
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– Diagnostic Accuracy of History Taking and Physical Examination for Assessing Anterior Cruciate Ligament Lesions of the Knee…
Satisfaction of patients and primary care physicians with shared decision making.
Eval Health Prof. 2010 Sep;33(3):321-42
Authors: Hirsch O, Keller H, Albohn-Kühne C, Krones T, Donner-Banzhoff N
Satisfaction with treatment is regarded as an important outcome measure, but its suitability has not been thoroughly investigated in the context of shared decision making (SDM). The authors evaluated whether both patients’ and physicians’ satisfaction ratings differ between an intervention group and a control group within a structured tool for cardiovascular prevention (ARRIBA-Herz). In a pragmatic, cluster-randomized, controlled trial, 44 family physicians in the intervention group consecutively recruited 550 patients whereas 47 physicians in the control group included 582 patients. Main findings were high satisfaction ratings independent of group allocation in patients and physicians. Significant differences had only negligible effect sizes. Compared to global satisfaction ratings, the effects of the shared decision-making process are better measured by a more concrete approach representing different steps of this process. Further research should refine behaviorally oriented questionnaires that measure SDM and a version for physicians should also be created.
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– Satisfaction of patients and primary care physicians with shared decision making.
Patient resistance towards diagnosis in primary care: Implications for concordance.
Health (London). 2010 Sep;14(5):505-22
Authors: Ijäs-Kallio T, Ruusuvuori J, Peräkylä A
This article reports a conversation analytic study of patients’ resisting responses after doctors’ diagnostic statements. In these responses, patients bring forward information that confronts the doctor’s diagnostic information. We examine two turn formats – aligning and misaligning – with which patients initiate resistance displays, and describe conversational resources of resistance the patients resort to: their immediate symptoms, their past experiences with similar illness conditions, information received in past medical visits and their diagnostic expectations that have been established earlier in the consultation.Through the deployment of these resources, patients orient to the doctor’s diagnostic information as negotiable and seek to further a shared understanding with the doctor on their condition. The results are discussed with regard to concordance as a process in which patients and doctors arrive at a shared understanding on the nature of the illness and its proper treatment. Our analysis illuminates the mechanisms in interaction in and through which concordance can be realized. Thus, we suggest that concordance can be seen to encompass not only treatment discussion but also the process where participants reach agreement about the diagnosis. The data of the study consist of 16 sequences of patients’ resisting responses to diagnosis and is drawn from 86 Finnish primary care visits for upper respiratory tract infections.
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– Patient resistance towards diagnosis in primary care: Implications for concordance.
