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This is the second of a series of evidence-based case conferences. The main aim of this new series of papers is help clinicians learn and apply the evidence-based approach in their own clinical practices. The clinical question that we seek to solve in each of this series emanates from a real clinical case. I have completely anonymised the scenario but I still hope it remains as real as it was. The presentation in this series may appear too brief and rushed, but this is how EBM can be practiced by busy clinicians once you are familiar with the process. This issue's clinical question is about diagnosis. The case conference below illustrates how to critically appraise and apply an article about a diagnostic test. We anticipate that the third of the series will deal with a clinical question of prognosis.
Patient: 77-year-old woman
Present illness: The patient is a mother of four children who have all gotten married and left home. After her husband passed away with lung cancer several years earlier, she had been living alone, occasionally attending the elderly people's gatherings but generally leading a quiet life. Two of her daughters live in the neighbourhood and come by several times a month for a chat.
It has been almost a year that the patient talked to her family about ‘children visiting her in her room’ and that she saw them hiding in the tree outside the window of her house too. At first, the patient's daughters did not take it seriously, but the patient described them very vividly with no apparent doubt as to their veracity. The patient seems to have had repeated falls in the house but, on questioning by her daughters, could not recall the details. She has become forgetful and sometimes cannot even recall the family's phone calls …
Competing interests None.
↵i MMSE is the most commonly used test for examining cognitive functions and screening for dementia. It has 11 questions and its maximum score is 30, with the commonly used threshold to raise suspicion of dementia is 24/23.
↵ii DLB is a neurocognitive disorder characterised by progressive cognitive impairment, fluctuations in attention and alertness, recurrent complex visual hallucination, REM sleep behaviour disorders and/or spontaneous features of parkinsonism. When parkinsonism precedes onset of dementia, it is often differentiated from DLB and is called Parkinson's disease with dementia (PDD).
↵iii MIBG is an analogue of norepinephrine and its uptake by the heart is hampered under local myocardial sympathetic nerve damage, not only in primary heart disease but also in neurological disorders with autonomic failure, such as Parkinson's disease or DLB.
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