Epidemiology for the uninitiated. What is a case? Dichotomy or continuum?

Rose, Gisela; Barker, D. J. P.

doi:10.1136/bmj.2.6141.873

Cited by 42 publications

(11 citation statements)

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“…After appraising various methods to establish a cut point, we adopted the clinical significance approach (9). We considered two methods for quantifying the level of DD: 1) the total number of items endorsed as "a serious problem" (i.e., rated 5-6) and 2) the summed PAID-T score.…”

Section: Cut Point Analysismentioning

confidence: 99%

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Cut Points for Identifying Clinically Significant Diabetes Distress in Adolescents With Type 1 Diabetes Using the PAID-T: Results From Diabetes MILES Youth–Australia

et al. 2017

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Using the PAID-T, this study defined two clinically meaningful cut points to distinguish none-to-mild, moderate, and high diabetes distress in adolescents (aged 13-19). Based on these cut points, most respondents experienced at least moderate diabetes distress, which was clinically significant. Establishing thresholds for elevated diabetes distress will aid clinicians and researchers to interpret PAID-T scores, prompt discussion and intervention for those with unmet needs, and enable the effectiveness of interventions to be evaluated.

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Section: Cut Point Analysismentioning

confidence: 99%

“…Therefore, other empirical approaches are required to establish a cut point. In 1978 Rose and Barker (9) outlined four approaches to determine a cut point on a continuous scale based on the intended purpose and available data:…”

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confidence: 99%

Cut Points for Identifying Clinically Significant Diabetes Distress in Adolescents With Type 1 Diabetes Using the PAID-T: Results From Diabetes MILES Youth–Australia

et al. 2017

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“…Doubt is often classified in the literature as " disagreement " (Emery, 1962;Prutting, 1967;Holler and de Morgan, 1970;Bauer and Robbins, 1972;Britton, 1974a and b ;Waldron and Wickerstaff, 1975) but, here, as in Heasman and Lipworth's study it was " surprising how rare it was to find what appeared to be a serious mistake in the sense that a correct diagnosis might have saved the patient's life ", as most of these patients were admitted too late for any effective treatment. " Misdiagnosis " was therefore, in the present circumstances, not " alarming at individual patient level '' (Rose and Barker, 1978). The basic problem in these cases, one in ten of the total cancer deaths in the district served (Statistisk Sentral Byrii, 1976), was thus the late stage at which they presented rather than the diagnostic problems they posed.…”

Section: Discussionmentioning

confidence: 68%

Autopsy findings in cases with a clinically uncertain cancer diagnosis

Hartveit

1979

The Journal of Pathology

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Analysis of the post mortem and clinical evaluation of the underlying cause of death in 471 cancer patients showed that doubt in the clinical situation occurred in approximately one case in four. Doubt was of three kinds, that as to the site of origin of the cancer, that related to lack of morphological confirmation and that as to the aetiology of the disease process. In most cases in the first two groups the decision not to resolve the doubt until post mortem was made clinically. The majority of the others were admitted too late for the doubt to be resolved before death.

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“…Rather, it identifies a continuum of disease severity [13]. For example, a recent study by Taupin et al found that 45% of participants screened for colorectal cancer had either hyperplastic (benign) or adematous (pre-cancerous) polyps which were removed [14].…”

Section: Discussionmentioning

confidence: 99%

Measuring the psychosocial consequences of screening

Brodersen

McKenna

Doward

et al. 2007

Health Qual Life Outcomes

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The last three decades have seen a dramatic rise in the implementation of screening programmes for cancer in industrialised countries. However, in contrast to screening for infectious diseases, most cancer screening programmes only have the potential to reduce mortality; they cannot lower the incidence of cancer in a population. In fact, most cancer screening programmes have been shown to increase the incidence of the disease as a consequence of over-diagnosis. A further dilemma of cancer screening programmes is that they do not distinguish between healthy people and those with disease. Rather, they identify a continuum of disease severity. Consequently, many healthy people who have abnormal screening tests are wrongly diagnosed. Indeed, studies have demonstrated that for each screening-prevented death from cancer, at least 200 false-positive results are given. Therefore, screening has the potential to be harmful as well as beneficial. The psychosocial consequences of false-positive screening results cannot be determined by diagnostic tests or by other technical means. Instead, patient reported outcome measures must be employed. To measure the outcomes of screening accurately and comprehensively patient reported outcome measures have to capture; the nature and extent of the psychosocial consequences and how these change over time. The outcome measures used must have high content validity and their psychometric properties should be determined prior to their use in the specific population. In particular it is important to establish unidimensionality, additivity and item ordering through the application of Item Response Theory.

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Epidemiology for the uninitiated. What is a case? Dichotomy or continuum?

Cited by 42 publications

References 0 publications

Cut Points for Identifying Clinically Significant Diabetes Distress in Adolescents With Type 1 Diabetes Using the PAID-T: Results From Diabetes MILES Youth–Australia

Cut Points for Identifying Clinically Significant Diabetes Distress in Adolescents With Type 1 Diabetes Using the PAID-T: Results From Diabetes MILES Youth–Australia

Autopsy findings in cases with a clinically uncertain cancer diagnosis

Measuring the psychosocial consequences of screening

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