Teleneurology by Internet and Telephone

Larner, A. J.

doi:10.1007/978-0-85729-691-7

Cited by 16 publications

(4 citation statements)

References 127 publications

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“…thus differs significantly from the phase III question of a pragmatic diagnostic test accuracy study: the former is an observational study whereas the latter may be considered to be part of an experimental paradigm. The author has previously and incorrectly, according to these defi nitions, used the term "audit" in the titles of papers which report diagnostic test accuracy studies Larner , 2006a, as well as appropriately in reports examining compliance with external standards (Larner 2011 ). In the former examples, "audit of established practice" may be cognate with "diagnostic test accuracy study" (and hence the study exempt from institutional ethical or research board review).…”

Section: Phase Iii: Pragmatic Diagnostic Test Accuracy Studiesmentioning

confidence: 99%

Diagnostic Test Accuracy Studies in Dementia

Larner

2015

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Section: Phase Iii: Pragmatic Diagnostic Test Accuracy Studiesmentioning

confidence: 99%

Diagnostic Test Accuracy Studies in Dementia

Larner

2015

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“…This measure is arguably more intuitive to clinicians and patients than more traditional measures of discrimination. Adaptations of NNT have been described (e.g., “number needed to harm” (NNH) [ 6 ]; “number needed to see” (NNS) [ 7 ]). Analogous adaptations may be relevant to diagnostic test accuracy studies.…”

Section: Introductionmentioning

confidence: 99%

Number Needed to Diagnose, Predict, or Misdiagnose: Useful Metrics for Non-Canonical Signs of Cognitive Status?

Larner

2018

Dement Geriatr Cogn Disord Extra

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Background/Aims: “Number needed to” metrics may hold more intuitive appeal for clinicians than standard diagnostic accuracy measures. The aim of this study was to calculate “number needed to diagnose” (NND), “number needed to predict” (NNP), and “number needed to misdiagnose” (NNM) for neurological signs of possible value in assessing cognitive status. Methods: Data sets from pragmatic diagnostic accuracy studies examining easily observed and dichotomised neurological signs (“attended alone” sign, “attended with” sign, head turning sign, applause sign, la maladie du petit papier) were analysed to calculate the NND, NNP, and NNM. Results: All measures of discrimination showed broad ranges. The range of NND and NNP suggested that these signs were, with a single exception, of value for correctly diagnosing or predicting cognitive status (presence or absence of cognitive impairment) when between 2 and 4 patients were examined. However, NNM showed similar values (range 1–5 patients) suggesting risk of misdiagnosis. Conclusion: NND, NNP, and NNM may be useful, intuitive, metrics in assessing the utility of diagnostic tests in day-to-day clinical practice. A ratio of NNM to either NND or NNP, termed the likelihood to diagnose or misdiagnose, may clarify the utility or inutility of diagnostic tests.

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“…In a 10‐year longitudinal study of internet use by patients newly referred to general neurology outpatient clinics (2,3), the lowest proportional internet access and use was found in the over 70 years age group, the very group in whom health needs are greatest. However, the null hypothesis that the proportion of older patients with access to the internet in each year over the 10 years (2001–2010) did not differ significantly was rejected, concordant with data showing increased Internet access in all age segments of the UK population (http://www.statistics.gov.uk/cci/nugget.asp?id=8).…”

mentioning

confidence: 99%

“…Only about 5% of all internet users in the study volunteered that they had searched the internet for medical information before being asked specifically during the consultation (2,3).…”

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confidence: 99%

Internet use

Larner¹

2011

International Journal of Clinical Practice

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Hocken with interest (1). However, I believe there is a logical reason as to why there is a discrepancy between internet prevalence and population prevalence of certain cancers. In the study the authors identified overrepresentation of kidney, stomach and breast cancers and underrepresentation of colorectal, non-Hodgkin lymphoma and oesophageal cancers. Collectively, the overrepresented cancers tend to affect younger people compared with the underrepresented cancers. Data from Cancer Research UK show that 81% of breast cancer and 95% of stomach cancer occur in people aged more than 50 years (2). While the highest incidence rates of kidney cancer occur in the over 75 years, notably incidence rates already start to increase in those over 40 years (2). On the other hand, 84% of colorectal cancer, 70% of non-Hodgkin lymphoma and 80% of oesophageal cancer occur in people aged more than 60 years (2).The Office of National Statistics (ONS) published an 'Internet Access' survey in 2010 (3). The report states that 80% of 45-54 year olds, 74% of 55-64 year olds and 59% of over 65 year olds used the internet daily or nearly daily in 2010. On a similar trend, 84, 72 and 32% of 45-54 year olds, 55-64 year olds and over 65 year olds, respectively, last used the internet 3 months ago or less. While there are particular difficulties in comparing these two sets of data, for example the age categories do not match perfectly, the conclusion we can

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Teleneurology by Internet and Telephone

Cited by 16 publications

References 127 publications

Diagnostic Test Accuracy Studies in Dementia

Diagnostic Test Accuracy Studies in Dementia

Number Needed to Diagnose, Predict, or Misdiagnose: Useful Metrics for Non-Canonical Signs of Cognitive Status?

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