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Clinical Assessment of Reliability of Examination (CARE)

One of the most exciting new developments in e-medical research is that on the Clinical Assessment of the Reliability of the Examination, which is a collaborative study of the accuracy and precision of the clinical examination. If you want to know all about it, it's Internet address is .

The all-too-common study of the accuracy and precision of the clinical examination comprises four experts examining 40 patients, the latter selected to confirm the biases and reputations of the former. The pioneering work of the US-Canadian Co-operative Research Group on the Clinical Exam reversed this trend, but even it has faced formidable problems in participation rates and patient numbers.

A group of Canadians currently working at the NHS R&D Centre for Evidence-Based Medicine in Oxford are trying to solve the problems of both numbers and clinical applicability by catalysing the execution of large (>100 clinicians enrolling >1000 patients), simple (<2 minutes per patient and <15 patients per participating clinician), fast (<2 weeks, with automatic data entry via the Internet) studies of the accuracy and precision of specific elements of the history and physical examination. Their initial efforts led to >160 clinicians from 20 countries joining CARE.

CARE works like this:

The first study is now undergoing data analysis and has evaluated the validity of a 2-minute examination in ruling-in/out chronic obstructive airways disease. Nominations for other studies are flooding in. Membership already is over 165, but the target is at least 1000 colleagues around the world. The objectives are good science, better examinations, and lots of fun. The people running the show are Sharon Straus, Finlay McAlister, and David Sackett.

Use the address above to get in touch, or follow their progress in adding science to the art of diagnosis.
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