Date of download: 7/11/2016 From: Laboratory Evaluation in the Diagnosis of Lyme Disease Ann Intern Med. 1997;127(12):1109-1123. doi:10.7326/0003-4819-127-12-199712150-00011.

Slides:



Advertisements
Similar presentations
Date of download: 5/28/2016 From: Effect of Nonpayment for Hospital-Acquired, Catheter-Associated Urinary Tract Infection: A Statewide Analysis Ann Intern.
Advertisements

Date of download: 5/28/2016 From: High-Dose Acyclovir Compared with Short-Course Preemptive Ganciclovir Therapy To Prevent Cytomegalovirus Disease in Liver.
Date of download: 5/29/2016 From: The Effect of a Lower Target Blood Pressure on the Progression of Kidney Disease: Long-Term Follow- up of the Modification.
Date of download: 6/1/2016 From: The Ann Arbor Criteria for Appropriate Urinary Catheter Use in Hospitalized Medical Patients: Results Obtained by Using.
Date of download: 6/1/2016 From: Cost-Effectiveness of Alternative Management Strategies for Patients with Solitary Pulmonary Nodules Ann Intern Med. 2003;138(9):
Date of download: 6/3/2016 From: Mortality Rates in Elderly Patients Who Take Different Angiotensin-Converting Enzyme Inhibitors after Acute Myocardial.
Date of download: 6/3/2016 From: Chest Pain Relief by Nitroglycerin Does Not Predict Active Coronary Artery Disease Ann Intern Med. 2003;139(12):
Date of download: 6/3/2016 From: Sex, Age, and Birth Cohort Effects in Colorectal Neoplasms: A Cohort Analysis Ann Intern Med. 2010;152(11): doi: /
Date of download: 6/3/2016 From: Elevated Plasma Homocysteine Level Is an Independent Predictor of Coronary Heart Disease Events in Patients with Type.
Date of download: 6/3/2016 From: Increased Incidence of Aortic Aneurysm and Dissection in Giant Cell (Temporal) Arteritis: A Population- Based Study Ann.
Date of download: 6/6/2016 From: Comparative Effectiveness of Pain Management Interventions for Hip Fracture: A Systematic Review Ann Intern Med. 2011;155(4):
Date of download: 6/17/2016 From: Treatment of Rheumatoid Arthritis with Gammalinolenic Acid Ann Intern Med. 1993;119(9): doi: /
Date of download: 6/21/2016 From: The Epidemiology of Prescriptions Abandoned at the Pharmacy Ann Intern Med. 2010;153(10): doi: /
Date of download: 6/21/2016 From: Aspirin, Statins, or Both Drugs for the Primary Prevention of Coronary Heart Disease Events in Men: A Cost–Utility Analysis.
Date of download: 6/22/2016 From: The Efficacy of Influenza Vaccine in Elderly Persons: A Meta-Analysis and Review of the Literature Ann Intern Med. 1995;123(7):
Date of download: 6/22/2016 From: An Evaluation of d-Dimer in the Diagnosis of Pulmonary Embolism: A Randomized Trial Ann Intern Med. 2006;144(11):
Date of download: 6/23/2016 From: Meta-Analysis: Acupuncture for Low Back Pain Ann Intern Med. 2005;142(8): doi: /
Date of download: 6/24/2016 From: Effectiveness of Manual Physical Therapy and Exercise in Osteoarthritis of the Knee: A Randomized, Controlled Trial Ann.
Date of download: 6/26/2016 From: Variations in Mortality and Length of Stay in Intensive Care Units Ann Intern Med. 1993;118(10): doi: /
Date of download: 6/27/2016 From: Interpreting HIV Serodiagnostic Test Results in the 1990s: Social Risks of HIV Vaccine Studies in Uninfected Volunteers.
Date of download: 6/28/2016 From: Meta-Analysis: Low-Dose Dopamine Increases Urine Output but Does Not Prevent Renal Dysfunction or Death Ann Intern Med.
Date of download: 6/28/2016 From: Sensitivity and Specificity of a Single Emergency Department Measurement of Urinary Neutrophil Gelatinase–Associated.
Date of download: 6/29/2016 From: Predicting Future Functional Status for Seriously Ill Hospitalized Adults: The SUPPORT Prognostic Model Ann Intern Med.
Date of download: 6/29/2016 From: Inviting Patients to Read Their Doctors' Notes: A Quasi-experimental Study and a Look Ahead Ann Intern Med. 2012;157(7):
Date of download: 7/1/2016 From: Does Utilization of Screening Mammography Explain Racial and Ethnic Differences in Breast Cancer? Ann Intern Med. 2006;144(8):
Date of download: 7/1/2016 From: A Quantitative Immunochemical Fecal Occult Blood Test for Colorectal Neoplasia Ann Intern Med. 2007;146(4): doi: /
Date of download: 7/2/2016 From: An Acute Change in Lung Allocation Score and Survival After Lung Transplantation: A Cohort Study Ann Intern Med. 2013;158(9):
Date of download: 7/3/2016 From: Preventing the Nosocomial Transmission of Tuberculosis Ann Intern Med. 1995;122(9): doi: /
Date of download: 7/5/2016 From: Sunscreen and Prevention of Skin Aging: A Randomized Trial Ann Intern Med. 2013;158(11): doi: /
Date of download: 7/6/2016 From: Can Inexpensive Signs Encourage the Use of Stairs? Results from a Community Intervention Ann Intern Med. 1998;129(5):
Date of download: 7/7/2016 From: Improved Diagnostic Evaluation of Suspected Tuberculosis Ann Intern Med. 2008;148(5): doi: /
Date of download: 7/7/2016 From: Research Training in Six Selected Internal Medicine Fellowship Programs Ann Intern Med. 2000;133(10): doi: /
Date of download: 7/8/2016 From: Did Medicare Part D Affect National Trends in Health Outcomes or Hospitalizations?: A Time-Series Analysis Ann Intern.
Date of download: 7/8/2016 From: Narrative Review: Initial Management of Newly Diagnosed, Early-Stage Chronic Lymphocytic Leukemia Ann Intern Med. 2006;145(6):
Date of download: 7/10/2016 From: β-Blockers in Congestive Heart Failure: A Bayesian Meta-Analysis Ann Intern Med. 2001;134(7): doi: /
Date of download: 9/16/2016 From: Fluorouracil plus Levamisole as Effective Adjuvant Therapy after Resection of Stage III Colon Carcinoma: A Final Report.
Date of download: 9/17/2016 From: Behavioral Therapy to Enable Women with Urge Incontinence to Discontinue Drug Treatment: A Randomized Trial Ann Intern.
Date of download: 9/17/2016 From: Topical Treatment of Pressure Ulcers with Nerve Growth Factor: A Randomized Clinical Trial Ann Intern Med. 2003;139(8):
Date of download: 9/17/2016 From: Polymerase Chain Reaction for the Diagnosis of HIV Infection in Adults: A Meta-Analysis with Recommendations for Clinical.
Date of download: 9/18/2016 From: Systematic Review: T-Cell–based Assays for the Diagnosis of Latent Tuberculosis Infection: An Update Ann Intern Med.
Date of download: 9/18/2016 From: Somatostatin Receptor Scintigraphy: Its Sensitivity Compared with That of Other Imaging Methods in Detecting Primary.
Date of download: 9/19/2016 From: The Implications of Regional Variations in Medicare Spending. Part 2: Health Outcomes and Satisfaction with Care Ann.
Date of download: 9/20/2016 From: Breast Cancer in Black Women Ann Intern Med. 1996;124(10): doi: / Age-specific.
From: Prevalence of Antineutrophil Cytoplasmic Antibodies in a Large Inception Cohort of Patients with Connective Tissue Disease Ann Intern Med. 1997;126(11):
From: Screening for Syphilis Infection in Pregnancy: U. S
Ann Intern Med. 2007;147(10): doi: / Figure Legend:
Ann Intern Med. 2010;153(7): doi: / Figure Legend:
Copyright © American Speech-Language-Hearing Association
From: Effects of Low-Carbohydrate and Low-Fat DietsA Randomized Trial
From: The Implications of Regional Variations in Medicare Spending
Ann Intern Med. 2005;143(6): doi: / Figure Legend: Flow of evidence.
From: Treatment of Very Early Rheumatoid Arthritis With Symptomatic Therapy, Disease-Modifying Antirheumatic Drugs, or Biologic AgentsA Cost-Effectiveness.
Ann Intern Med. 2014;160(11): doi: /M Figure Legend:
Ann Intern Med. 1999;130(6): doi: / Figure Legend:
From: An Externally Validated Model for Predicting Long-Term Survival after Exercise Treadmill Testing in Patients with Suspected Coronary Artery Disease.
From: Systematic Review: Strategies for Using Exercise Therapy To Improve Outcomes in Chronic Low Back Pain Ann Intern Med. 2005;142(9): doi: /
From: The Evolving Diabetes Burden in the United States
From: Case-Finding Instruments for Depression in Primary Care Settings
From: Long-Term Outcome of Anti–Glomerular Basement Membrane Antibody Disease Treated with Plasma Exchange and Immunosuppression Ann Intern Med. 2001;134(11):
Ann Intern Med. 2008;149(1): doi: / Figure Legend:
From: Screening for Lung Cancer With Low-Dose Computed Tomography: A Systematic Review to Update the U.S. Preventive Services Task Force Recommendation.
From: Upper Endoscopy for Gastroesophageal Reflux Disease: Best Practice Advice From the Clinical Guidelines Committee of the American College of Physicians.
Copyright © 2004 American Medical Association. All rights reserved.
From: Exercise Tomographic Thallium-201 Imaging in Patients with Severe Coronary Artery Disease and Normal Electrocardiograms Ann Intern Med. 1994;121(11):
From: Self-Measured Blood Pressure Monitoring in the Management of HypertensionA Systematic Review and Meta-analysis Ann Intern Med. 2013;159(3):
From: Clinic-Based Treatment of Opioid-Dependent HIV-Infected Patients Versus Referral to an Opioid Treatment ProgramA Randomized Trial Ann Intern Med.
COUNTERPOINT: Should BAL Be Routinely Performed in the Diagnostic Evaluation of Idiopathic Pulmonary Fibrosis? No  Joshua J. Mooney, MD, Harold R. Collard,
Clinical Utility of Likelihood Ratios
Volume 134, Issue 2, Pages (August 2008)
The role of likelihood ratio in clinical diagnosis: Applicability in the setting of spontaneous bacterial peritonitis  Fernando Sierra, Diana Torres,
Presentation transcript:

Date of download: 7/11/2016 From: Laboratory Evaluation in the Diagnosis of Lyme Disease Ann Intern Med. 1997;127(12): doi: / Rates of Lyme disease cases in the United States in 1993 as reported by states to the Centers for Disease Control and Prevention.[28]Shown by endemic county. Counties with rates less than 5 per or with fewer than five cases reported are not highlighted. Rates in highly endemic counties ranged from 30 per to more than 400 per Figure Legend: Copyright © American College of Physicians. All rights reserved.American College of Physicians

Date of download: 7/11/2016 From: Laboratory Evaluation in the Diagnosis of Lyme Disease Ann Intern Med. 1997;127(12): doi: / Scenario A: utility of enzyme-linked immunosorbent assay (ELISA) in patients with nonspecific myalgia.leftrightA nomogram is used to calculate the post-test probability from the pretest probability as follows. The nomogram expresses probability as a percentage, as modified from the method of Sackett and colleagues. For a patient with an pretest probability of Lyme disease, the straight edge was anchored at on the pretest column of the nomogram. Because the likelihood ratio (represented by the center line) for a positive ELISA result was 5.0 ( ), the straight edge was directed through the central column at 5. The post-test probability was then read as from the post-test column of the nomogram. The post-test probability can also be calculated for pretest probabilities of 0.01 and For a probability of , the post-test probability cannot be calculated from this nomogram. For a patient with an 0.01 pretest probability of Lyme disease, the straight edge was anchored at 0.01 on the pretest column of the nomogram. Because the likelihood ratio for a positive ELISA result was 5.0, the straight edge was directed through the central column at 5. The post-test probability was then read as 0.04 from the post-test column of the nomogram. For a patient with an 0.03 pretest probability of Lyme disease, the straight edge was anchored at 0.03 on the pretest column of the nomogram. Because the likelihood ratio for a positive ELISA result was 5.0, the straight edge was directed through the central column at 5. The post-test probability was then read as 0.13 from the post-test column of the nomogram. For a negative ELISA result, the likelihood ratio is 0.06 ( ). The procedure is the same as that for a positive result. For a patient with an 0.03 pretest probability of Lyme disease, the straight edge was anchored at 0.03 on the pretest column of the nomogram and the straight edge was directed through the central column at The post-test probability was then read as The 0.01 (moderate) and (low) pretest probabilities reduce to less than 1 in 1000; these probabilities are so low that it is not important to have a precise estimate. Figure Legend: Copyright © American College of Physicians. All rights reserved.American College of Physicians

Date of download: 7/11/2016 From: Laboratory Evaluation in the Diagnosis of Lyme Disease Ann Intern Med. 1997;127(12): doi: / Scenario B: utility of enzyme-linked immunosorbent assay (ELISA) in patients with possible erythema migrans.A nomogram is used to calculate the post-test probability from the pretest probability as follows. The nomogram expresses probability as a percentage, as modified from the method of Sackett and colleagues. For a patient with an 0.80 pretest probability of Lyme disease, the straight edge was anchored at 0.80 on the pretest column of the nomogram. Because the likelihood ratio (represented by the center line) for a positive ELISA result was 0.80, the straight edge was directed through the central column at 8. The post-test probability was then read as 0.98 from the post-test column of the nomogram. Conversely, because the likelihood ratio for a negative ELISA result was 0.44, the post-test probability was read as Figure Legend: Copyright © American College of Physicians. All rights reserved.American College of Physicians

Date of download: 7/11/2016 From: Laboratory Evaluation in the Diagnosis of Lyme Disease Ann Intern Med. 1997;127(12): doi: / Scenario C: utility of enzyme-linked immunosorbent assay (ELISA) in patients who have arthritis and a 0.50 pretest probability of Lyme disease. A nomogram is used to calculate the post-test probability from the pretest probability as follows. The nomogram expresses probability as a percentage, as modified from the method of Sackett and colleagues. The likelihood ratio (represented by the center line) was approximately 1000 for the clinical signs and symptoms present in the patient in scenario C. If the cutoff for a positive ELISA result is increased to at least 3 SDs above controls, the likelihood ratio increases to 19.5 and the post-test probability can then be read as For a patient with an 0.50 pretest probability of Lyme disease, the straight edge was anchored at 0.50 on the pretest column of the nomogram. Because the likelihood ratio for a positive ELISA result was 5.0, the straight edge was directed through the central column at 5. The post-test probability was read as 0.83 from the post-test column of the nomogram. Conversely, because the likelihood ratio for a negative ELISA result was 0.06, the post-test probability was read as Figure Legend: Copyright © American College of Physicians. All rights reserved.American College of Physicians

Date of download: 7/11/2016 From: Laboratory Evaluation in the Diagnosis of Lyme Disease Ann Intern Med. 1997;127(12): doi: / Utility of the Western blot for indeterminate enzyme-linked immunosorbent assay (ELISA) results.A nomogram is used to calculate the post-test probability from the pretest probability as follows. The nomogram expresses probability as a percentage, as modified from the method of Sackett and colleagues. For a patient with an 0.50 pretest probability of Lyme disease, the straight edge was anchored at 0.50 on the pretest column of the nomogram. Because the likelihood ratio (represented by the center line) for a positive ELISA result was 0.20, the straight edge was directed through the central column at The post-test probability was then read as If the ELISA result is indeterminant, the likelihood ratio is 1.05 and the post-test probability is If 0.51 is now the pretest probability and Western blot has a positive result, the likelihood ratio is This yields a post-test probability of Figure Legend: Copyright © American College of Physicians. All rights reserved.American College of Physicians

Feedback: Privacy Policy Feedback
Do Not Sell My Personal Information
About project: SlidePlayer Terms of Service

© 2025 SlidePlayer.com. Inc. All rights reserved.