CANNOT MAKE THE DIAGNOSIS?

Lorri Zipperer Lorri at ZPM1.COM
Thu Apr 10 14:18:19 UTC 2014


From: Robert Bell [mailto:rmsbell at esedona.net] 
Sent: Wednesday, April 09, 2014 3:14 PM
To: Society to Improve Diagnosis in Medicine
Subject: Re: [IMPROVEDX] CANNOT MAKE THE DIAGNOSIS?

 

Robert, if you were KING what would you do?!

 

Rob Bell

Sent from my iPad


On Apr 9, 2014, at 1:38 PM, "Swerlick, Robert A" <rswerli at EMORY.EDU> wrote:

It is hard to know where to start if we want to deal with imprecise diagnostic language. Unfortunately, imprecise language is the rule, not the exception. 

 

Robert A. Swerlick, MD

Alicia Leizman Stonecipher Chair of Dermatology

Professor and Chairman, Department of Dermatology

Emory University School of Medicine

404-727-3669 


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From: robert bell [rmsbell at ESEDONA.NET]
Sent: Wednesday, April 09, 2014 3:15 PM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: Re: [IMPROVEDX] CANNOT MAKE THE DIAGNOSIS?

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.   

 


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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
 <mailto:thomas_carroll at urmc.rochester.edu> 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] <http://www.medscape.com/viewarticle/753447_5%5bmedscape.com%5d> 

 

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

 


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