Mustafa Reem A, Wiercioch Wojtek, Cheung Adrienne, Prediger Barbara, Brozek Jan, Bossuyt Patrick, Garg Amit X, Lelgemann Monika, Büehler Diedrich, Schünemann Holger J
Department of Health Research Methods, Evidence and Impact (formerly "Clinical Epidemiology and Biostatistics"), McMaster University, 1280 Main Street West Hamilton, ON L8S 4K1, Canada; Departments of Internal Medicine, University of Kansas Medical Center, 3901 Rainbow Blvd, MS3002, Kansas City, KS 66160, USA.
Department of Health Research Methods, Evidence and Impact (formerly "Clinical Epidemiology and Biostatistics"), McMaster University, 1280 Main Street West Hamilton, ON L8S 4K1, Canada.
J Clin Epidemiol. 2017 Dec;92:18-28. doi: 10.1016/j.jclinepi.2017.09.003. Epub 2017 Sep 12.
In this first of a series of five articles, we provide an overview of how and why healthcare-related tests and diagnostic strategies are currently applied. We also describe how our findings can be integrated with existing frameworks for making decisions that guide the use of healthcare-related tests and diagnostic strategies.
We searched MEDLINE, references of identified articles, chapters in relevant textbooks, and identified articles citing classic literature on this topic.
We provide updated frameworks for the potential roles and applications of tests with suggested definitions and practical examples. We also discuss study designs that are commonly used to assess tests' performance and the effects of tests on people's health. These designs include diagnostic randomized controlled trials and retrospective validation. We describe the utility of these and other currently suggested designs, which questions they can answer and which ones they cannot. In addition, we summarize the challenges unique to decision-making resulting from the use of tests.
This overview highlights current challenges in the application of tests in decision-making in healthcare, provides clarifications, and informs the proposed solutions.
在这一系列五篇文章的第一篇中，我们概述了当前医疗相关检查和诊断策略的应用方式及原因。我们还描述了如何将我们的研究结果与现有的决策框架相结合，这些框架指导医疗相关检查和诊断策略的使用。
我们检索了MEDLINE、已识别文章的参考文献、相关教科书的章节，并识别了引用该主题经典文献的文章。
我们提供了关于检查潜在作用和应用的更新框架，并给出了建议定义和实际示例。我们还讨论了常用于评估检查性能以及检查对人们健康影响的研究设计。这些设计包括诊断随机对照试验和回顾性验证。我们描述了这些以及其他当前建议设计的效用，它们能回答哪些问题以及不能回答哪些问题。此外，我们总结了因使用检查而导致的决策中特有的挑战。
本概述突出了当前在医疗决策中应用检查所面临的挑战，提供了相关阐释，并为提出的解决方案提供了信息。
