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Users' Guides to the Medical Literature:  III. How to Use an Article About a Diagnostic Test A. Are the Results of the Study Valid?

Roman Jaeschke, MD, MSc; Gordon Guyatt, MD, MSc; David L. Sackett, MD, MSc; Eric Bass, MD, MPH; Patrick Brill-Edwards, MD; George Browman, MD, MSc; Deborah Cook, MD, MSc; Michael Farkouh, MD; Hertzel Gerstein, MD, MSc; Brian Haynes, MD, MSc, PhD; Robert Hayward, MD, MPH; Anne Holbrook, MD, PharmD, MSc; Roman Jaeschke, MD, MS; Elizabeth Juniper, MCSP, MSc; Hui Lee, MD, MSc; Mitchell Levine, MD, MSc; Virginia Moyer, MD, MPH; Jim Nishikawa, MD; Andrew Oxman, MD, MSc, FACPM; Ameen Patel, MD; John Philbrick, MD; W. Scott Richardson, MD; Stephane Sauve, MD, MSc; David Sackett, MD, MSc; Jack Sinclair, MD; K. S. Trout, FRCE; Peter Tugwell, MD, MSc; Sean Tunis, MD, MSc; Stephen Walter, PhD; Mark Wilson, MD, MPH
JAMA. 1994;271(5):389-391. doi:10.1001/jama.1994.03510290071040.
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CLINICAL SCENARIO  You are a medical consultant asked by a surgical colleague to see a 78-year-old woman, now 10 days after abdominal surgery, who has become increasingly short of breath over the last 24 hours. She has also been experiencing what she describes as chest discomfort, which is sometimes made worse by taking a deep breath (but sometimes not). Abnormal findings on physical examination are restricted to residual tenderness in the abdomen and scattered crackles at both lung bases. Chest roentgenogram reveals a small right pleural effusion, but this is the first roentgenogram since the operation. Arterial blood gases show a Po2 of 70 mm Hg, with a saturation of 92%. The electrocardiogram shows only nonspecific changes.You suspect that the patient, despite receiving 5000 U of heparin twice a day,

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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