Book Proposal

Objective

To create a manual for veterinary students, residents and clinicians that can aid in evidence-based diagnostic approaches. Provide information on questions to ask, how to search for answers, critical review of the diagnostic literature, appropriate metrics for accuracy and how to combine metrics to move from a pre-test to a post-test probability of the target condition. Tables of important diagnostic test accuracy metrics for diagnostic tests across species of interest to veterinarians.

Introduction

• Role of diagnostic tests in the diagnostic process

• History of evidence based diagnostic approach

• Advantages and disadvantages of this approach

Asking an Answerable Question

• Difference between diagnostic accuracy and utility

• What is the purpose of test on clinical pathway? Replacement, Triage, Add-On or Screening

• P-population I-Index Test R-reference standard T-target population

• How to search the literature for studies

Study Appraisal

• Optimal study design for tests of diagnostic accuracy

• Precison and bias

• Dichotomization of Continuous measures

• Thresholds

• Outcome measures (sensitivity, specificity, predictive values, likelihood ratios, DOR, ROC curve) pros and cons

Clinical

• Clinical approach to quantitative diagnostic approach

• Determining pre-test probability

• Selecting evidence for useful diagnostic accuracy metrics

• Updating target condition probability with test results (single or multiple tests)

• Optimal test metrics for different test purposes (Screening, Triage, Replacement or Add On)

• Examples

• Simple methods for calculations : apps, Fagan’s nomogram etc

Glossary

Tables

• Tables of diagnostic tests stratified by species

• Include test name, target condition, DSe, DSp, LR+ve, LR-ve, source, study design