This article in the current Journal of Family Practice is hard to get at, as the site is poorly designed and only subscribers are allowed in. This is odd, since the journal is mailed free to all family physicians. Who are they really keeping out? And there are advertisements inside the site. Today I couldn't remember my password, so I clicked the little thing that told me to enter my e-mail address to have them e-mail it to me. But it didn't recognize my e-mail address. So I figger it forgot who I am .. so I went into the study and found a copy of the paper version not-yet-recycled .. found the billion-digit secret subscriber ID and typed it in. "This account is already enabled."
So then I have to go back and type in all of the e-mail addresses that I've ever had since 1997 and finally hit on one and then they e-mail me the dumb password.
This isn't how it should work. If I found the long secret number — they should say OK and at least send an e-mail to the account associated with the number – or permit me to edit my record.
Oh … was I posting about the poor usability? no .. sorry ..
… the article was actually quite good. It's a clinical question/answer on pharyngitis, which includes this pretty table on Centor Scores … and a well written little review on the non-controversy on whether to do culture follow-up on rapid antigen assays:
"A retrospective outcome study reviewed the frequency of suppurative complications of GABHS among 30,036 patients with pharyngitis diagnosed with either RAD testing or throat culture. Patients included adults and children in a primary care setting. Complication rates were identical. A prospective study of 465 suburban outpatients with pharyngitis assessed the accuracy of RAD diagnosis using throat culture as a reference. The RAD accuracy was 93% for pediatric patients and 97% for adults.5 In another retrospective review of RAD testing, investigators performed 11,427 RAD tests over 3 years in a private pediatric group. There were 8385 negative tests, among which follow-up cultures detected 200 (2.4%) that were positive for GABHS. In the second half of the study, a newer RAD test produced a false-negative rate of 1.4%.7 Because of the possibility of higher false-negative RAD test rates in some settings, unless the physician has ascertained that RAD testing is comparable to throat culture in their own setting, expert opinion recommends confirming a negative RAD test in children or adolescents with a throat culture.1 Patients at higher risk of GABHS or GABHS complications may also warrant throat culture back up of RAD testing."
The money is in the pre-test probability. The nursery school teacher who called Sunday afternoon with a Centor score of 4 deserved a trip to the office to meet me and get tested (positive). The stock broker who called Saturday with no ill contacts, no kids and a Centor score of 3 was given instructions for symptom relief.