Less life threatening differential diagnoses

Vipindas Chengat syncopesystem at GMAIL.COM
Sun Aug 2 21:43:16 UTC 2015


Very interesting post. Addressing sensitivity/specificity/ LR or predictive
values would pose another challenge. How would we calculate the base rate?
Is it just the prevalence of the population or the clinic's population? How
can we generalize those numbers? Mathematical strategy using Bayesian might
not be the perfect method; but looking for patterns based on
patho-physiological relations might be. That is how I built physician
cognition's decision algorithm and it is doing very well( I think). It can
even incorporate combined wisdom of professionals to optimize the decision
rules ( you can find it here beta.physiciancognition.com).
Dr. Ebell, if you would like to conduct any research to optimize decision
pathways, I can provide it for free of cost. You can try any number of
symptoms, signs and labs in any combination and system will provide
differential diagnosis in the order of relevance, suggest further testing -
can be a clinical sign, symptom or lab and decision tree will move forward
based on answering those questions. You can also teach the system in real
time or it can learn from a big database. Please let me know what you
think. I think I have solved the very specific problem of combination of
symptoms. I believe that if there are any sub-optimal results, it is just a
matter of data and not the algorithm and can be solved within minutes.



*Vipindas Chengat, MD FACP**  |  *Chairman, Physician Cognition, Inc.
  —————————————————————————————————
  Mobile: +1 (773) 575-3550
  Email: Vipin at PhysicianCognition.Com <Vipin at PhysicianCognition.com>
  Website: PhysicianCognition.Com <http://physiciancognition.com/>



On Sun, Aug 2, 2015 at 4:08 PM, Mark H Ebell <ebell at uga.edu> wrote:

> While very useful in many ways, that approach would not address
> sens/spec/LR, would not help with acute problems, and would not address
> combinations of symptoms, at least not easily
>
> Sent from Outlook
> <http://t.sidekickopen13.com/e1t/c/5/f18dQhb0S7lC8dDMPbW2n0x6l2B9nMJW7t5XZs5v_-llVcV_H264zw8vW653gwx56dBNpf9ks1lC02?t=http%3A%2F%2Ftaps.io%2Foutlookmobile&si=5919500165185536&pi=0c808af1-4c80-483f-b574-ba96e200f54f>
>
>
>
>
> On Sun, Aug 2, 2015 at 9:47 AM -0700, "Jochanan Benbassat" <
> benbasat at jdc.org> wrote:
>
> Unlike hospital based specialists, primary care physicians have the
> advantage of prolonged follow up of patients. Outpatient records offer the
> opportunity to determine the predictive value of abnormal syptoms and
> signs. In 1982 Dr Froom and I published in the BMJ the prevalence of
> microscopic hematuria in otherwise healthy male airpersonel aged 18-35 and
> the (negative) results of an average 7 years fillow up. I believe that a
> fsimilar ocus on the prevalence and outcomes of selected disease
> manifestations in the community after follow up offers an opportunity for
> such research
>
>
>
> Jochanan Benbassat MD
>
> Jerusaltm Israel
>
> ------------------------------
>
> *From:* Mark H Ebell [ebell at UGA.EDU]
> *Sent:* Sunday, August 02, 2015 16:21
> *To:* IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
> *Subject:* Re: [IMPROVEDX] Less life threatening differential diagnoses
>
> Blow up NIH. Well ok, not literally. The average age at first RO1 is now
> 40, and less than 1% of funding goes to what one could generously call
> primary care research. And none to study of clinical diagnosis. PCORI even
> expressly forbids research to develop and validate clinical decision rules.
> This research is not expensive, but proper reference standards (PCR,
> imaging) cost money.
>
> Sent from Outlook
> <http://t.sidekickopen13.com/e1t/c/5/f18dQhb0S7lC8dDMPbW2n0x6l2B9nMJW7t5XZs5v_-llVcV_H264zw8vW653gwx56dBNpf9ks1lC02?t=http%3A%2F%2Ftaps.io%2Foutlookmobile&si=5919500165185536&pi=0c808af1-4c80-483f-b574-ba96e200f54f>
>
>
>
>
> On Sun, Aug 2, 2015 at 5:19 AM -0700, "Robert Bell" <rmsbell200 at yahoo.com>
> wrote:
>
> Excellent point. How to change things? What to do to get the funding?
>
> Rob Bell
>
> Sent from my iPad
>
> On Aug 1, 2015, at 8:58 PM, Mark H Ebell <ebell at UGA.EDU> wrote:
>
> As a primary care physician, we often see diseases early in their course,
> when signs and symptoms overlap with other conditions and biomarkers may be
> negative (think lupus). Unfortunately, there is no funding in the US to
> study clinical diagnosis in the primary care setting, at least not as long
> as NIH is dominated by basic scientists and sub specialists. That would be
> the only way to identify the truly useful signs and symptoms (or more
> likely combinations).
>
> Mark
>
>> Mark H. Ebell MD, MS
> Professor of Epidemiology University of Georgia
> Editor, *Essential Evidence* Deputy Editor, *American Family Physician*
> ebell at uga.edu
>
>
> From: Carmel Crock
> Reply-To: Society to Improve Diagnosis in Medicine, Carmel Crock
> Date: Saturday, August 1, 2015 at 9:55 PM
> To: " <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
> IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG"
> Subject: Re: [IMPROVEDX] Less life threatening differential diagnoses
>
> Dear Rob
> I thought I would mention that at our Eye and ENT hospital emergency
> department, shingles is one of our commonest missed or delayed diagnosis,
> as patients present early with severe eye or ear pain but nothing (or
> little) to show on clinical examination.
> Regards
> Carmel Crock
> ------------------------------
> *From:* robert bell [
> <0000000296e45ec4-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG>
> 0000000296e45ec4-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG]
> *Sent:* Sunday, 2 August 2015 9:08 AM
> *To:* <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
> IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
> *Subject:* [IMPROVEDX] Less life threatening differential diagnoses
>
> To me it seems that despite frequency patterns medical students are
> rightly taught at great length to focus on not missing the life threatening
> diagnosis. Is this done at the expense of missing the diagnosis with less
> dangerous competing conditions that are on the differential diagnostic
> list.
>
> For example, how much do most medical students/residents know about
> shingles pain and symptoms prior to lesion development, with any lack of
> knowledge leading to the “diagnosis” of possible acute abdomen?
>
> I would argue that in training knowing FAR more about the less dangerous
> differential diagnoses would get us more quickly to an accurate diagnosis,
> at possibly lesser cost.
>
> So should there be in training more focus on the less serious competing
> differential diagnoses?
>
> Rob Bell
>
>
>
>
>
>
>
>
>
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Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine


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