BackgroundAlthough guidelines for critical appraisal of diagnostic research and meta-analyses have already been published, these may be difficult to understand for clinical researchers or do not provide enough detailed information.MethodsDevelopment of guidelines based on a systematic review of the evidence in reports of systematic searches of the literature for diagnostic research, of methodological criteria to evaluate diagnostic research, of methods for statistical pooling of data on diagnostic accuracy, and of methods for exploring heterogeneity.ResultsGuidelines for conducting diagnostic systematic reviews are presented in a stepwise fashion and are followed by comments providing further information. Examples are given using the results of two systematic reviews on the accuracy of the urine dipstick in the diagnosis of urinary tract infections, and on the accuracy of the straight-leg-raising test in the diagnosis of intervertebral disc hernia.

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This is a reprint of a Cochrane review, prepared and maintained by The Cochrane Collaboration and published in The Cochrane Library 2011, Issue 2 http://www.thecochranelibrary.com Physical examination for lumbar radiculopathy due to disc herniation in patients with low-back pain (Review)

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PURPOSE Although dizzy patients are predominantly seen in primary care, most diagnostic studies on dizziness have been performed among patients in secondary or tertiary care. Our objective was to describe subtypes of dizziness in elderly patients in primary care and to assess contributory causes of dizziness.METHODS We performed a cross-sectional diagnostic study among elderly patients in the Netherlands consulting their family physician for persistent dizziness. All patients underwent a comprehensive evaluation according to a set of diagnostic tests that were developed during an international Delphi procedure. Data for each patient were independently reviewed by a panel consisting of a family physician, a geriatrician, and a nursing home physician, which resulted in major and minor contributory causes of dizziness.RESULTS From June 2006 to January 2008, we included 417 patients aged 65 to 95 years. Presyncope was the most common dizziness subtype (69%). Forty-four percent of the patients were assigned more than 1 dizziness subtype. Cardiovascular disease was considered to be the most common major contributory cause of dizziness (57%), followed by peripheral vestibular disease (14%), and psychiatric illness (10%). An adverse drug effect was considered to be the most common minor contributory cause of dizziness (23%). Sixty-two percent of the patients were assigned more than 1 contributory cause of dizziness. CONCLUSIONSContrary to most previous studies, cardiovascular disease was found to be the most common major cause of dizziness in elderly patients in primary care. In one-quarter of all patients an adverse drug effect was considered to be a contributory cause of dizziness, which is much higher than reported in previous studies.Ann Fam Med 2010;8:196-205. doi:10.1370/afm.1116. INTRODUCTIOND izziness is common in elderly people; 30% of people older than 65 years experience dizziness in some form, [1][2][3][4] increasing to 50% in the very old (older than 85 years).1 For clinicians, dizziness often represents a diagnostic problem: it is a subjective sensation that depends on self-report, it may refer to several different and overlapping sensations, and it can be caused by a wide range of benign or serious conditions. 5,6 In 20% to 40% of dizzy patients in primary care, the underlying cause remains unknown. [7][8][9] Patients with dizziness are managed largely at primary care level. 10 From 1985 to 1995, Dutch family physicians referred only 3% of dizzy elderly patients to a medical specialist.11 Most diagnostic studies on dizziness, however, have been performed among patients seen in emergency departments 8,12,13 or in a secondary or tertiary care setting. 5,[14][15][16][17][18][19] Because of selective referral, the distribution of diagnoses in secondary and tertiary care patients is probably different from patients in primary care (spectrum variation PER SIS T EN T DIZ ZINES S IN EL DER LY PAT IEN T Sobjective of this study was to describe subtypes of dizziness in elderly patients in primary care and...