Less life threatening differential diagnoses

Vipindas Chengat syncopesystem at GMAIL.COM
Mon Aug 3 03:03:56 UTC 2015


Dr. Hamm,

  Thank you. I have registered for the conference. Just to clarify, it is
not a logic- non probabilistic system. It is based on Bayesian. However, I
do recognize the issues of simply using a number from a study and making it
universal. Another issue is with the base rate; whether to use prevalence
of the population versus the the demographic characteristics of the study
population. I just wanted to mention that. Thanks again!

Vipin

*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 9:00 PM, Hamm, Robert M. (HSC) <Robert-Hamm at ouhsc.edu
> wrote:

> Dr. Chengat,
>
> It is not surprising that Dr. Ebell raises the question of sensitivity,
> specificity, likelihood ratio; that has been the language of those
> addressing this problem for decades. John Fox in the 1980's (now at Oxford)
> articulated the alternative, to have a non-probabilistic "possibilistic"
> logic, and based on expert opinion. It is fun that you have a working
> "diagnoser", as many of us do, but you need a full challenge test of it for
> the field to take it seriously.
>
> Come to the Society for Medical Decision Making meetings in Saint Louis
> (Oct 20), or to the Society for Improvement of Diagnosis in Medicine, and
> talk with the attendees and develop a plan to provide an objective test for
> your product. I'll be at SMDM.
>
> Rob
>
>
> Robert M. Hamm, PhD
> Clinical Decision Making Program
> Department of Family and Preventive Medicine
> University of Oklahoma Health Sciences Center
> 900 NE 10th Street
> Oklahoma City OK 73104
> 405 271 5362 ext 32306       Fax 405 271 2784
> robert-hamm at ouhsc.edu
> ------------------------------
> *From:* Vipindas Chengat [syncopesystem at GMAIL.COM]
> *Sent:* Sunday, August 02, 2015 4:43 PM
>
> *To:* IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
> *Subject:* Re: [IMPROVEDX] Less life threatening differential diagnoses
>
> 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
> <https://urldefense.proofpoint.com/v2/url?u=http-3A__beta.physiciancognition.com&d=AwMFaQ&c=qRnFByZajCb3ogDwk-HidsbrxD-31vTsTBEIa6TCCEk&r=xRJEBCjBmL1ypS8G4qfsiN0ww2Uty8FEqU-Ye79RFyM&m=dWtZoAwruRtTV7N8YZtLMsgFADwtOprtB7ideYXkT8o&s=m2UWyGNHgGZ68V3YgJoudkeLI9jpholQe4RUlimo1R0&e=>).
>
> 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
> <https://urldefense.proofpoint.com/v2/url?u=http-3A__physiciancognition.com_&d=AwMFaQ&c=qRnFByZajCb3ogDwk-HidsbrxD-31vTsTBEIa6TCCEk&r=xRJEBCjBmL1ypS8G4qfsiN0ww2Uty8FEqU-Ye79RFyM&m=dWtZoAwruRtTV7N8YZtLMsgFADwtOprtB7ideYXkT8o&s=vtWsYWMQIrtZ-8S7a6n0FrDfjt_zIWQa5ty-gD7CLAw&e=>
>
>
>
> 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
>> <https://urldefense.proofpoint.com/v2/url?u=http-3A__t.sidekickopen13.com_e1t_c_5_f18dQhb0S7lC8dDMPbW2n0x6l2B9nMJW7t5XZs5v-5F-2DllVcV-5FH264zw8vW653gwx56dBNpf9ks1lC02-3Ft-3Dhttp-253A-252F-252Ftaps.io-252Foutlookmobile-26si-3D5919500165185536-26pi-3D0c808af1-2D4c80-2D483f-2Db574-2Dba96e200f54f&d=AwMFaQ&c=qRnFByZajCb3ogDwk-HidsbrxD-31vTsTBEIa6TCCEk&r=xRJEBCjBmL1ypS8G4qfsiN0ww2Uty8FEqU-Ye79RFyM&m=dWtZoAwruRtTV7N8YZtLMsgFADwtOprtB7ideYXkT8o&s=JuobR2owsj6U2_qpQ84zVeKSQKcL5h4SQwR7mLEcs88&e=>
>>
>>
>>
>>
>> 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
>> <https://urldefense.proofpoint.com/v2/url?u=http-3A__t.sidekickopen13.com_e1t_c_5_f18dQhb0S7lC8dDMPbW2n0x6l2B9nMJW7t5XZs5v-5F-2DllVcV-5FH264zw8vW653gwx56dBNpf9ks1lC02-3Ft-3Dhttp-253A-252F-252Ftaps.io-252Foutlookmobile-26si-3D5919500165185536-26pi-3D0c808af1-2D4c80-2D483f-2Db574-2Dba96e200f54f&d=AwMFaQ&c=qRnFByZajCb3ogDwk-HidsbrxD-31vTsTBEIa6TCCEk&r=xRJEBCjBmL1ypS8G4qfsiN0ww2Uty8FEqU-Ye79RFyM&m=dWtZoAwruRtTV7N8YZtLMsgFADwtOprtB7ideYXkT8o&s=JuobR2owsj6U2_qpQ84zVeKSQKcL5h4SQwR7mLEcs88&e=>
>>
>>
>>
>>
>> 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 for Improving Diagnosis in
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>> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
>> Medicine
>>
>> To learn more about SIDM visit:
>> http://www.improvediagnosis.org/
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> or send email to: IMPROVEDX-SIGNOFF-REQUEST at LIST.IMPROVEDIAGNOSIS.ORG
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>
>
> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
> Medicine
>
> To learn more about SIDM visit:
> http://www.improvediagnosis.org/
>
>






Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine


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