Andrew Ribner, Alex M Silver, Leanne Elliott, Melissa E Libertus
Exploring effects of an early math intervention: The importance of parent-child interaction
Child development
primary care general practitioners gps unavoidably reach clinical judgement patient part encounter patients clinical judgement important part diagnostic evaluation typically clinical decision making next patient incorporates clinical judgement diagnosis severity symptoms patient factors ideas expectations treatment evaluating patients dementia many gps report using judgement evaluate cognition using information immediately available point care decide whether someone dementia rather formal tests determine diagnostic accuracy gps clinical judgement diagnosing cognitive impairment dementia symptomatic people presenting primary care investigate heterogeneity test accuracy included studies searched medline ovid sp embase ovid sp psycinfo ovid sp web science core collection isi web science lilacs bireme 16 september 2021 selected crosssectional cohort studies primary care clinical judgement determined gp either prospectively consulting patient presented specific encounter doctor retrospectively based knowledge patient review medical notes relating specific encounter patient target conditions dementia cognitive impairment mild cognitive impairment dementia included studies appropriate reference standard diagnostic statistical manual mental disorders dsm international classification diseases icd aetiological definitions expert clinical diagnosis two review authors screened titles abstracts relevant articles extracted data separately differences resolved consensus discussion used quadas2 evaluate risk bias concerns applicability study using anchoring statements performed metaanalysis using bivariate method identified 18202 potentially relevant articles 12427 remained deduplication assessed 57 fulltext articles extracted data 11 studies 17 papers 10 studies quantitative data included eight studies metaanalysis target condition dementia four studies target condition cognitive impairment studies low risk bias assessed quadas2 tool except flow timing domain four studies high risk bias reference standard domain two studies high risk bias studies low concern applicability review question quadas2 domains average age ranged 73 years 83 years weighted average 77 years percentage female participants studies ranged 47 100 percentage people final diagnosis dementia 2 56 across studies weighted average 21 target condition dementia individual studies sensitivity ranged 34 91 specificity ranged 58 99 metaanalysis dementia target condition eight studies total 826 2790 participants dementia summary diagnostic accuracy clinical judgement general practitioners sensitivity 58 95 confidence interval ci 43 72 specificity 89 95 ci 79 95 positive likelihood ratio 53 95 ci 24 82 negative likelihood ratio 047 95 ci 033 061 target condition cognitive impairment individual studies sensitivity ranged 58 97 specificity ranged 40 88 summary diagnostic accuracy clinical judgement general practitioners four studies total 594 1497 participants cognitive impairment sensitivity 84 95 ci 60 95 specificity 73 95 ci 50 88 positive likelihood ratio 31 95 ci 14 47 negative likelihood ratio 023 95 ci 006 040 impossible draw firm conclusions analysis heterogeneity small numbers studies specificity found data compatible studies used icd10 applied retrospective judgement higher reported specificity compared studies dsm definitions using prospective judgement contrast sensitivity found studies used prospective index test may higher sensitivity studies used retrospective index test clinical judgement gps specific sensitive diagnosis dementia would necessary use additional tests confirm diagnosis either target condition confirm absence target conditions clinical judgement may inform choice testing many people gp judges dementia condition people false negative diagnoses likely less severe disease could identified using formal testing people gps judge dementia false positives may require similar practical support dementia people depression may suffer delayed intervention alternative treatable pathology