Andrew M. Fine

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BACKGROUND The Centor and McIsaac scores guide testing and treatment for group A streptococcal (GAS) pharyngitis in patients presenting with a sore throat, but they were derived on relatively small samples. We perform a national-scale validation of the prediction models on a large, geographically diverse population. METHODS We analyzed data collected from(More)
INTRODUCTION Although Lyme disease can cause peripheral facial palsy in Lyme disease-endemic areas, diagnostic predictors in children have not been described. OBJECTIVE Our goal was to determine clinical predictors of Lyme disease as the etiology of peripheral facial palsy in children presenting to an emergency department in a Lyme disease-endemic area.(More)
BACKGROUND AND OBJECTIVES Thirty-five percent of children experience syncope at least once. Although the etiology of pediatric syncope is usually benign, many children undergo low-yield diagnostic testing. We conducted a quality improvement intervention to reduce the rates of low-yield diagnostic testing for children presenting to an emergency department(More)
One hundred three patients with neovascular maculopathy and relatively recent vision loss were surveyed to determine the most frequent symptoms and to assess the reliability of the Amsler grid in helping patients to detect early symptoms. Blurred vision and distortion, most often with near vision, were the most frequent first symptoms reported by patients.(More)
Central visual function is characteristically reported as Snellen acuity at distance and near. We performed functional tests in a group of patients with visual acuity of 20/100 or worse due to macular disease to determine whether there was a relationship between Snellen acuity and functional performance among these patients with poor visual acuity. Our(More)
BACKGROUND Consensus guidelines recommend against testing or treating adults at low risk for group A streptococcal (GAS) pharyngitis. OBJECTIVE To help patients decide when to visit a clinician for the evaluation of sore throat. DESIGN Retrospective cohort study. SETTING A national chain of retail health clinics. PATIENTS 71 776 patients aged 15(More)
OBJECTIVE Broadly, to create a bidirectional communication link between public health surveillance and clinical practice. Specifically, to measure the impact of integrating public health surveillance data into an existing clinical prediction rule. We incorporate data about recent local trends in meningitis epidemiology into a prediction model(More)
PURPOSE We aim to develop and validate the positive predictive value (PPV) of an algorithm to identify anaphylaxis using health plan administrative and claims data. Previously published PPVs for anaphylaxis using International Classification of Diseases, ninth revision, Clinical Modification (ICD-9-CM) codes range from 52% to 57%. METHODS We conducted a(More)
BACKGROUND Clinical prediction rules do not incorporate real-time incidence data to adjust estimates of disease risk in symptomatic patients. OBJECTIVE To measure the value of integrating local incidence data into a clinical decision rule for diagnosing group A streptococcal (GAS) pharyngitis in patients aged 15 years or older. DESIGN Retrospective(More)
Objective To improve identification of pertussis cases by developing a decision model that incorporates recent, local, population-level disease incidence. Design Retrospective cohort analysis of 443 infants tested for pertussis (2003–7). Measurements Three models (based on clinical data only, local disease incidence only, and a combination of clinical data(More)