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Improving Decisions in Clinical Medicine Chapter 8
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Bayes Theorum A somewhat convoluted theory that is used in the mathematical exercise of determining probability. If a patient has symptom A what is the probability that the symptom is caused by a certain disease?
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Example… A fourteen year old girl goes to the county fair, during the course of a three hour visit to the fair, she eats a funnel cake, cotton candy, and a candy apple after consuming a foot-long chili dog.
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Two hours after arriving home from the fair she is rushed to the local ER for stomach pains, dizziness and vomiting.
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The Visit Upon arrival at the ER, blood chemistries and a CBC are drawn as well as collection of a free catch urine sample.
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Patient Data Examination: Temperature 98.7 Pulse 84 Respiration 24 Weight 136 Height 5 ft 6 Laboratory Report Complete Blood Count: within normal limits Chemistries: Within normal limits except for glucose (sugar) which is 198 Normal glucose reading is 100-120
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Symptoms of Diabetes Increased water consumption Weight gain or loss (unexpected) Glucose readings that are above normal Increased and frequent urination Frequent night-time urination
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Question Based on the history of the patient and what we now know of diabetes, does this patient have diabetes?
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Bayes Theorum A way of predicting through observation of probability whether or not a symptom is caused by a disease.
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Hmmm… If a population has a low prevalence (occurrence) of a disease, it is likely that positive results may be false positives They should be examined further before a diagnosis is positively made This is an area where good epidemiological examination can make all the difference in avoiding a panic.
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Evidence Based Medicine A form of medical practice that: Bases a diagnosis on symptoms + prevalence Relies heavily on the use of Bayes Theorum Must perform tests to rule out diseases as part of the diagnostic process Uses a sequential approach to tests Begin with most sensitive test for fastest and most accurate results Continues with other tests in a sequence until a satisfactory answer is arrived at (i.e. diagnosis)
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Decision Trees A method of improving decision making in times of uncertainly A way of outlining ones thoughts and rationale concerning a medical dilemma Create a decision tree Identify/set limits to the problem Diagram options Obtain information on each option Compare the values Perform sensitivity analysis to arrive at an answer
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When to Use Decision Trees Clinical settings Public health problem solving
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Meta-analysis Defined: Collection of related methods used to combine data from similar studies to obtain the best estimate. Types: Pooled Quantitative Analysis: deals with actual numbers (i.e. quantity)
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Continued Methodological Qualitative Analysis: deals with quality or benefits derived from something such as a treatment or drug therapy.
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Questions
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Discussion Time
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Page 130, Figure 8-2 If you took your mother to the ER with the symptom of chest pain at rest, how would you feel about a physician using Figure 8-2 as a basis for his treatment decisions?
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The End Any questions, concerns or discourse on assignments so far within the course?
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