Frank Buntinx

The value of the CAGE in screening for alcohol abuse and alcohol dependence in general clinical populations: a diagnostic meta-analysis

OBJECTIVEnTo perform a meta-analysis to assess diagnostic characteristics of the CAGE in screening for alcohol abuse or dependence in a general clinical population and to test a new method for pooling of ROC curves.nnnMETHODSnMedline search performed over the period 1/1/1974 to 31/12/2001.nnnMEASUREMENTnCalculation of diagnostic values.nnnRESULTSnWe identified 35 articles using the DSM criteria as the gold standard to test the diagnostic value of the CAGE. Only 10 studies could be included for the meta-analysis. With a cutoff point > or =2, the pooled sensitivity is far better in inpatients (0.87) than in primary care patients (0.71) or ambulatory patients (0.60). The pooled specificity also differs for each group. The likelihood ratios seem to be relatively constant over the populations (overall LR+:3.44;LR-:0.18). We calculated a pooled AUC of 0.87 (95% CI 0.85-0.89). At low specificity values, the sensitivity was homogeneous over the studies, and at a low sensitivity, the specificity was heterogeneous.nnnCONCLUSIONnThe diagnostic value of the CAGE is of limited value using this test for screening purposes at his recommended cutpoint of > or =2.

Triage of women with equivocal or low-grade cervical cytology results: a meta-analysis of the HPV test positivity rate

•u2002 Introduction •u2002 Methods •u2002 Results •u2002 Discussion •u2002 Conclusion

Implementing evidence-based medicine in general practice: a focus group based study.

BackgroundOver the past years concerns are rising about the use of Evidence-Based Medicine (EBM) in health care. The calls for an increase in the practice of EBM, seem to be obstructed by many barriers preventing the implementation of evidence-based thinking and acting in general practice. This study aims to explore the barriers of Flemish GPs (General Practitioners) to the implementation of EBM in routine clinical work and to identify possible strategies for integrating EBM in daily work.MethodsWe used a qualitative research strategy to gather and analyse data. We organised focus groups between September 2002 and April 2003. The focus group data were analysed using a combined strategy of between-case analysis and grounded theory approach. Thirty-one general practitioners participated in four focus groups. Purposeful sampling was used to recruit participants.ResultsA basic classification model documents the influencing factors and actors on a micro-, meso- as well as macro-level. Patients, colleagues, competences, logistics and time were identified on the micro-level (the GPs individual practice), commercial and consumer organisations on the meso-level (institutions, organisations) and health care policy, media and specific characteristics of evidence on the macro-level (policy level and international scientific community). Existing barriers and possible strategies to overcome these barriers were described.ConclusionIn order to implement EBM in routine general practice, an integrated approach on different levels needs to be developed.