CANNOT MAKE THE DIAGNOSIS?

robert bell rmsbell at ESEDONA.NET
Wed Apr 9 19:15:14 UTC 2014


Thanks Alan.

Agree, agree.

Also, it seems to me that the diagnostic definitions are, in the main, proposed by Specialty Societies who MAY be biased for economic reasons. I am not sure if this is the case and would welcome comment. If it is the case, shining lights might help.

The other issue would seem to be that if there is a condition/disease that is not well defined with current parameters would a list of these published by IMPROVEDX be of any value so that others can refine things? After all, looking for Errors in diagnosis becomes hard if there are no good defined diagnostic criteria for certain diseases (which supports your thesis Alan).

Fine, kind, courteous medical/scientific interaction with Specialty Societies would be a great way to grow the organization, impart  the importance of the mission, and make an impact for all!

Position papers could make a big statement.

Rob Bell



On Apr 9, 2014, at 11:23 AM, Alan Morris <Alan.Morris at IMAIL.ORG> wrote:

> Those of you who have paid attention to my past suggestions about standardization might see in this exchange the problems that surface when standards are absent.  Some would assign to chronic renal insufficiency those whom others think normal.
> Have  a nice day.
> 
> Alan H. Morris, M.D.
> Professor of Medicine
> Adjunct Prof. of Medical Informatics
> University of Utah
> 
> Director of Research
> Director Urban Central Region Blood Gas and Pulmonary Laboratories
> Pulmonary/Critical Care Division
> Sorenson Heart & Lung Center - 6th Floor
> Intermountain Medical Center
> 5121 South Cottonwood Street
> Murray, Utah  84157-7000, USA
> 
> Office Phone: 801-507-4603
> Mobile Phone: 801-718-1283
> Fax: 801-507-4699
> e-mail: alan.morris at imail.org
> e-mail: alanhmorris at gmail.com
> 
> From: Harold Szerlip <hszerlip at GMAIL.COM>
> Reply-To: Society to Improve Diagnosis in Medicine <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>, Harold Szerlip <hszerlip at GMAIL.COM>
> Date: Wednesday, April 9, 2014 10:03 AM
> To: "IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG" <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
> Subject: Re: [IMPROVEDX] CANNOT MAKE THE DIAGNOSIS?
> 
> I think you should look at the KDIGO definition of CKD.  CKD 3 A (eGFR 45-60) without proteinuria, which would be the majority of the CKD in the elderly has a minimal increased cardiovascular risk. It is proteinuria that is associated with an increase in risk. This is likely secondary to underlying endothelia dysfunction.  The PREVEND study supports this.
> 
> Harold Szerlip, MD, FACP, FCCP, FASN, FNKF
> 
> On Apr 9, 2014, at 9:55 AM, Hayward, Rodney (Rod) <rhayward at MED.UMICH.EDU> wrote:
> 
>> For the vast majority, the most important implication of CKD is elevated CV risk. In this regard, the current classification is suboptimal in that early stage 3 CKD (eGFR 45-60) only elevates CV risk moderately, but advanced stage 3 (eGFR 30-45) results in a dramatic increase in CV risk.  
>> 
>> From: Carroll, Thomas [Thomas_Carroll at URMC.ROCHESTER.EDU]
>> Sent: Wednesday, April 09, 2014 9:23 AM
>> To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
>> Subject: Re: [IMPROVEDX] CANNOT MAKE THE DIAGNOSIS?
>> 
>> It seems to me that the definition of CKD (especially in the elderly, but I suppose in everyone) really only matters in the context of an individual’s expected survival.  If they’re very unlikely to outlive their kidney function, then it doesn’t matter and vice versa.
>>  
>> Thomas M. Carroll M.D., Ph.D.
>> Assistant Professor, General Medicine & Palliative Care
>> University of Rochester
>> thomas_carroll at urmc.rochester.edu
>> Pager 5-1616 #3872
>> Tel: 585-275-7424 (General Medicine Office)
>> Tel: 585-273-1154 (Palliative Care Office)
>>  
>> From: robert bell [mailto:rmsbell at ESEDONA.NET] 
>> Sent: Wednesday, April 09, 2014 1:12 AM
>> To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
>> Subject: Re: [IMPROVEDX] CANNOT MAKE THE DIAGNOSIS?
>>  
>> There are a group of diagnoses where we do not have enough data/information to make a firm diagnosis. 
>>  
>> This link relates to age and renal failure  http://www.medscape.com/viewarticle/753447_5[medscape.com]
>>  
>> It is said here: "Therefore, it is not clear to what extent a decline in GFR with age is physiological and what level of GFR should be considered abnormal in older people."
>>  
>> So how can we say some elderly people definitely have Chronic Renal Failure?
>>  
>> So should the first thing be to clarify better what is Chronic Renal failure in elderly people.
>>  
>> Could there be Errors in Diagnosis here because the renal failure standards are incorrect?!
>>  
>> Rob Bell
>>  
>> 
>> 
>> To unsubscribe from IMPROVEDX: click the following link:
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>> 
>> Moderator: Lorri Zipperer Lorri at ZPM1.com, Communication co-chair, Society for Improving Diagnosis in Medicine
>> 
>> To learn more about SIDM visit:
>> http://www.improvediagnosis.org/
>> 
>> 
>> 
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>> Visit the searchable archives or adjust your subscription at: http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?INDEX
>> 
>> 
>> Moderator: Lorri Zipperer Lorri at ZPM1.com, Communication co-chair, Society for Improving Diagnosis in Medicine
>> 
>> To learn more about SIDM visit:
>> http://www.improvediagnosis.org/
>> 
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>> 
>> Moderator: Lorri Zipperer Lorri at ZPM1.com, Communication co-chair, Society for Improving Diagnosis in Medicine
>> 
>> To learn more about SIDM visit:
>> http://www.improvediagnosis.org/
> 
> 
> 
> 
> To unsubscribe from IMPROVEDX: click the following link:
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> or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG
> 
> Visit the searchable archives or adjust your subscription at: http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?INDEX
> 
> 
> Moderator: Lorri Zipperer Lorri at ZPM1.com, Communication co-chair, Society for Improving Diagnosis in Medicine
> 
> To learn more about SIDM visit:
> http://www.improvediagnosis.org/
> 
> 
> 
> 
> To unsubscribe from IMPROVEDX: click the following link:
> http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?SUBED1=IMPROVEDX&A=1
> 
> or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG
> 
> Visit the searchable archives or adjust your subscription at: http://list.improvediagnosis.org/scripts/wa-IMPDIAG.exe?INDEX
> 
> 
> Moderator: Lorri Zipperer Lorri at ZPM1.com, Communication co-chair, Society for Improving Diagnosis in Medicine
> 
> To learn more about SIDM visit:
> http://www.improvediagnosis.org/
> 









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