For your written assignment, please write 2000 words on the following topic within clinical...

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For your written assignment, please write 2000 words on the following topic within clinical decision-making and diagnostic theory (50%).Please review the two assigned papers on the use of faecal elastase to diagnose chronic pancreatitis and complete the following:	Summarize whether the studies have been carried in accordance with the STARD diagnostic accuracy framework. You do not need to include all of the points of the STARD framework for each paper but pick out areas that have been covered particularly well, those that you think have not been well described or have errors in terms of the ability to predict diagnostic accuracy. Give each paper an overall score out of 25 for how well the study was conducted in accordance with the STARD guidelines (see checklist attached).(20%)		Based on your assessment of the two papers, do you think that the faecal elastase is a useful and accurate test to diagnose chronic pancreatitis?(10%)		Evaluate the use of faecal elastase in current clinical practice. Is the current use in diagnostic practice supported by the evidence from studies of diagnostic accuracy?(20%)	Untitled Document  STARD checklist for the reporting of studies of diagnostic accuracy.  First official version, January 2003.  Section and Topic Item #  On page #  TITLE/ABSTRACT/  KEYWORDS  1 Identify the article as a study of diagnostic accuracy (recommend MeSH heading  ’sensitivity and specificity’). INTRODUCTION 2 State the research questions or study aims, such as estimating diagnostic accuracy or  comparing accuracy between tests or across participant groups. METHODS      Participants 3 Describe the study population: The inclusion and exclusion criteria, setting and locations  where the data were collected.  4 Describe participant recruitment: Was recruitment based on presenting symptoms,  results from previous tests, or the fact that the participants had received the index tests  or the reference standard?  5 Describe participant sampling: Was the study population a consecutive series of  participants defined by the selection criteria in items 3 and 4? If not, specify how  participants were further selected.  6 Describe data collection: Was data collection planned before the index test and reference  standard were performed (prospective study) or after (retrospective study)?  Test methods 7 Describe the reference standard and its rationale.    8 Describe technical specifications of material and methods involved including how and  when measurements were taken, and/or cite references for index tests and reference  standard.  9 Describe definition of and rationale for the units, cutoffs and/or categories of the results of  the index tests and the reference standard.  10 Describe the number, training and expertise of the persons executing and reading the  index tests and the reference standard.  11 Describe whether or not the readers of the index tests and reference standard were  blind (masked) to the results of the other test and describe any other clinical information  available to the readers.  Statistical methods 12 Describe methods for calculating or comparing measures of diagnostic accuracy, and the  statistical methods used to quantify uncertainty (e.g. 95% confidence intervals).  13 Describe methods for calculating test reproducibility, if done.   RESULTS      Participants 14 Report when study was done, including beginning and ending dates of recruitment.    15 Report clinical and demographic characteristics of the study population (e.g. age, sex,  spectrum of presenting symptoms, comorbidity, current treatments, recruitment centers).  16 Report the number of participants satisfying the criteria for inclusion that did or did not  undergo the index tests and/or the reference standard; describe why participants failed to  receive either test (a flow diagram is strongly recommended).  Test results 17 Report time interval from the index tests to the reference standard, and any treatment  administered between.  18 Report distribution of severity of disease (define criteria) in those with the target  condition; other diagnoses in participants without the target condition. 19 Report a cross tabulation of the results of the index tests (including indeterminate and  missing results) by the results of the reference standard; for continuous results, the  distribution of the test results by the results of the reference standard.  20 Report any adverse events from performing the index tests or the reference standard.    Estimates 21 Report estimates of diagnostic accuracy and measures of statistical uncertainty  (e.g. 95% confidence intervals).  22 Report how indeterminate results, missing responses and outliers of the index tests were  handled.  23 Report estimates of variability of diagnostic accuracy between subgroups of participants,  readers or centers, if done.  24 Report estimates of test reproducibility, if done.   DISCUSSION 25 Discuss the clinical applicability of the study findings.       Faecal elastase 1: not helpful in diagnosing chronic pancreatitis associated with mild to moderate exocrine pancreatic insuYciency P G Lankisch, I Schmidt, H König, D Lehnick, R Knollmann, M Löhr, S Liebe Abstract Background/Aim—The suggestion that estimation of faecal elastase 1 is a valuable new tubeless pancreatic function test was evaluated by comparing it with faecal chy- motrypsin estimation in patients catego- rised according to grades of exocrine pancreatic insuYciency (EPI) based on the gold standard tests, the secretin- pancreozymin test (SPT) and faecal fat analysis. Methods—In 64 patients in whom EPI was suspected, the following tests were per- formed: SPT, faecal fat analysis, faecal chymotrypsin estimation, faecal elastase 1 estimation. EPI was graded according to the results of the SPT and faecal fat analysis as absent, mild, moderate, or severe. The upper limit of normal for fae- cal elastase 1 was taken as 200 µg/g, and for faecal chymotrypsin 3 U/g stool. Levels between 3 and 6 U/g stool for faecal chymotrypsin are usually considered to be suspicious for EPI. In this study, both 3 and 6 U/g stool were evaluated as the upper limit of normal. Results—Exocrine pancreatic function was normal in 34 patients, of whom 94, 91, and 79% had normal faecal elastase 1 and faecal chymotrypsin levels (67 ml/30 min, bicarbonate concentration >70 mmol/l, bicar- bonate output >6.5 mmol/30 min; after cholecystokinin-pancreozymin administration, amylase output >12 000 U/30 min, lipase out- put >65 000 U/30 min, and trypsin output >30 U/30 min; (b) faecal fat 200 µg/g stool; (d) faecal chymo- trypsin

Insha · Accepted Answer

Article Review 
Executive Summary
This paper is a critical review of two article based on the use of faecal elastase to diagnose chronic pancreatitis. One study shows that the estimate of faecal elastase 1 is a helpful new tubeless pancreatic function test, according to a research that compared it to previous tests like the secretinpancreozymin test (SPT). While In another study, for severe and moderate exocrine insufficiency, the faecal elastase-1 test has been demonstrated to be quite accurate. In an acute context, the goal of this study was to compare faecal ELAS-1 concentration [FE-1] to clinical criteria for chronicity. Initially it will be summarize if the research followed the principles of STARD and point out any areas where they were not adequately reported or had flaws. Further it will be discussed about the faecal elastase to diagnose chronic pancreatitis and its use in current clinical practice.
Table of Contents
Executive Summary	2
Introduction	4
STARD diagnostic accuracy framework	4
Article Analysis 1:	4
Article Analysis 2:	6
The faecal elastase to diagnose chronic pancreatitis	7
The use of faecal elastase in current clinical practice	8
Conclusion	9
References	10
Introduction
This paper is a critical review of two article based on the use of faecal elastase to diagnose chronic pancreatitis. One study shows that the estimate of faecal elastase 1 is a helpful new tubeless pancreatic function test, according to a research that compared it to previous tests like the secretinpancreozymin test (SPT). While In another study, for severe and moderate exocrine insufficiency, the faecal elastase-1 test has been demonstrated to be quite accurate. In an acute context, the goal of this study was to compare faecal ELAS-1 concentration [FE-1] to clinical criteria for chronicity. Initially it will be summarize if the research followed the principles of STARD and point out any areas where they were not adequately reported or had flaws. Further it will be discussed about the faecal elastase to diagnose chronic pancreatitis and its use in current clinical practice. 
STARD diagnostic accuracy framework 
Article Analysis 1: 
“Using faecal elastase-1 to screen for chronic pancreatitis in patients admitted with acute pancreatitis
Title – The Title goes along with diagnostic accuracy as Patients with acute pancreatitis may also have chronic pancreatitis, which would require correct diagnosis to determine the best course of treatment.
Aim - Gold standard tests are frequently intrusive, expensive, and time-consuming, although the faecal elastase-1 assay has been found to be quite reliable for moderate and severe exocrine deficiency. The goal of this study was to compare the concentration of faecal elastase-1 [FE-1] in an acute context to clinical criteria indicating chronicity.
Methodology - [FE-1] was used on individuals who had recently developed epigastric discomfort and had a serum lipase level that was at least three times the upper limit of normal. The presence of particular clinical, pathological, or radiological criteria for chronic pancreatitis determined the clinical diagnosis. Chronic exocrine insufficiency was also indicated by a [FE-1] result of B/200 mg/g. As a result, a 2/2 table was created to compare [FE-1] and clinical diagnosis.
Result - An analysis of the clinical diagnosis of chronic pancreatitis yielded a sensitivity of 79.5 percent, specificity of 98.0 percent, positive predictive value of 96.9%, and negative predictive value of 86.0 percent for the entire sample and then after excluding patients with moderate and severe acute pancreatitis (Ranson score /2). The latter study was predicated on a 200 mg/g exocrine insufficiency threshold.
Discussion – When obtained during a hospital admission for mild acute pancreatitis, [FE-1] is an accurate screening test for underlying chronic exocrine insufficiency.
The goal of this study was to see how effective [FE-1] was as an objective diagnostic tool in a clinical context, rather than comparing it to another pancreatic exocrine function test. It's a first-of-its-kind attempt to detect chronic pancreatitis in acute pancreatitis cases at the time of, or shortly after, the acute episode. The gold standard diagnostic criteria are all well-known characteristics of chronic pancreatic revelations. The use of [FE-1] in incident instances of acute pancreatitis produced unimpressive results for the standard diagnostic indicators. After excluding instances with moderate or severe acute illness, as indicated by Ranson's score, these significantly improved. Transient acinar cell failure or frank parenchymal necrosis can affect exocrine function, and the degree of the impairment corresponds with the level of necrosis seen on a CT scan.

For your written assignment, please write 2000 words on the following topic within clinical decision-making and diagnostic theory (50%). Please review the two assigned papers on the use of faecal...

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