Leventhal J M, Hutchinson T A, Kramer M S, Feinstein A R
JAMA. 1979 Nov 2;242(18):1991-4.
To determine how practicing clinicians use a recently developed algorithm for the diagnostic assessment of suspected adverse drug reactions (ADRs), eight clinicians--four board-certified, practicing physicians and four interns--rated the likelihood of 30 suspected ADRs. Each physician reviewed the case summaries, first using implicit clinical judgment and two months later by means of the ADR algorithm. The algorithm significantly improved the reproducibility of the senior clinicians' assessments as compared with their implicit assessments; however, the improvement in the interns' assessments with the algorithm was not significant. The validity of the physicians' assessments, which was measured by comparing their ratings with a consensus rating of the three algorithm developers, was also significantly improved by the use of the algorithm. When used by practicing clinicians, the algorithm improves the reproducibility and validity of their assessments of ADRs and should provide a more precise diagnostic approach to these complex clinical phenomena.
为了确定临床执业医生如何使用一种最近开发的用于疑似药物不良反应（ADR）诊断评估的算法，八位临床医生——四位获得委员会认证的执业医师和四位实习生——对30例疑似ADR的可能性进行了评级。每位医生先使用隐含的临床判断审查病例摘要，两个月后再通过ADR算法进行审查。与他们的隐含评估相比，该算法显著提高了资深临床医生评估的可重复性；然而，该算法对实习生评估的改善并不显著。通过将医生的评级与三位算法开发者的共识评级进行比较来衡量的医生评估的有效性，通过使用该算法也得到了显著提高。当临床执业医生使用该算法时，它提高了他们对ADR评估的可重复性和有效性，并且应该为这些复杂的临床现象提供一种更精确的诊断方法。
