Tests with high diagnostic specificity are often used after screening tests to confirm diagnoses. In addition to confirming a disease state, diagnostic tests may also reveal additional information as well about the severity of disease. They can yield useful prognostic information and establish a baseline for treatment monitoring and disease progression. Often, several diagnostic modalities can be used to seek a diagnosis in a symptomatic patient. Each test has unique characteristics of which a clinician should be aware. For example, both thoracic radiographs and computed tomography (CT) scan can be used to evaluate pulmonary metastases. CT scan is the more sensitive modality due to superior contrast resolution and diminished anatomic superimposition.[3,4] CT may be less specific though, since it detects more lesions, many of which may be nonneoplastic. It would make sense to use CT scan as a screening test. However, it is less readily available, more expensive, and requires general
is unlikely to create improvements in care for patients (Ramsey and Fulop, 2008) and can fail to alter the way in which doctors practise medicine and collaborate with other health care professionals (Burns and Pauly, 2002), which also requires underpinning clinical and normative changes in teamwork and care delivery. ·Integrative processes can have unintended effects. For instance, whilst targeted financial incentives can provide a valuable means of changing clinician behaviour, they can also increase bureaucracy, motivate unintended behaviours such as gaming or cherry-picking (Oxman and others, 2008), and potentially counteract the development of shared values and working practices (Rosen and others, 2011). 10 What is integrated care? Consideration needs to be given to the pace of change required when employing one or more integrative processes. There are fundamental ingredients of integration, including:
10. Lepp, A.: Siseelundid. Tartu 2000. 11. Nienstedt, W., Hänninen, O. jt: Inimese füsioloogia ja anatoomia. Medicina 2001. 12. Kaitseväe side-eeskiri. 13. N. L. Caroline Emergency Care in the Streets 1991. 14. Sepura tarkvara V7.2 kasutusjuhend 2007. 15. Teede- ja sideministri 31. oktoobri 2002. a määrus nr 71. 16. The Merck Manual of Diagnosis and Therapy (16th edition) 17. „Mini-Mental State“: A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12:189–198. 18. Seppo Alahuhta, Tero Ala-Kokko jt.: Infusioonravi. Medicina 2009 19. Bolton, P., Pediatric Anaesthesia 2000;10, 687–705 20. Bridges, E. Battlefield and Disaster Nursing Pocket Guide. 2009. 21. Eesti Perinatoloogia selts. Vastsündinu elustamine. 2010. 22. Eesti teise tüübi diabeedi juhend 2008. 23. European Resuscitation Counsil Guidelines for Resuscitation 2010. 24. John R. Hampton. EKG praktikas. 2006. 25. Kiirabi tegevusjuhised 2007. 26
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