Tuesday, June 14, 2016

Treatment Scores Tutorial 3: Creating the Diagnosis

Start with the diagnosis! When reviewing the medical literature and doing Journal Club about treatments we begin with the diagnosis. Especially, when producing Treatment Scores we always start with the diagnosis.

First, you go to http://TreatmentScores.com and register. You will receive a registration email (you might have to check your spam folder). Once your registration is complete you can login and see your dashboard.

At the top right of your dashboard will be the icon “Add Diagnosis,” which you want to click on to add your first diagnosis.


This will bring up a page for you to fill out about your diagnosis. Because we want “personalized medicine” you can put in up to 10 categories for your diagnosis. Start with the most general diagnosis, and then add in more specific terms as you go.


For example, you might want to start with the diagnosis “incontinence.” However, there are two kinds of incontinence, urinary and fecal. A person can be incontinent of urine or incontinent of feces. So put incontinence in the 1st cell, and put urinary in the 2nd cell.


In addition, I want to look at incontinence of urine associated with spina bifida. This means that my diagnosis is going to look like this: “incontinence, urinary, spina bifida.” In the graphic below I have used those three terms for my diagnosis.



That takes care of the top half of the diagnosis form. Now we need to look at the bottom half. The bottom half consists of the following items: the follow-up time period, a description of the patients, the main statistic, and the author or authors.




For “incontinence of urine associated with spina bifida,” I want to look at a follow-up time period of three years. The reason I am looking at three years is that there are several medical studies have a duration of three years. If there were a body of literature that went out to 5 years or 10 years, I could use those time periods as the follow-up. One of the big things you learn when doing Treatment Scores, is how shockingly short the follow-up time period is for many treatments that may affect someone’s life forever.

The patients I am interested in are children. So, I enter “children” in that cell.

The outcome I am interested in is “resolution of urinary incontinence.”



When you create a diagnosis, the “main statistic,” or main outcome measure, is the most important entry. The main statistic you’re most interested in is the main statistic that is “most important to the patient.” Patients come first. The main statistic also needs to be the hardest statistic possible. The reason I chose the “resolution of urinary incontinence” as my main outcome measure is because it is a “hard” outcome measure. Either the patient is incontinent of urine and is wearing diapers or pull-ups, or the patient is dry and is not wearing any diapers or pull-ups. It is a very clear-cut outcome measure.

The left half of your diagnosis looks like this:


The right half of your diagnosis looks like this:


To summarize the 6 things we have done to create a diagnosis:

  1. Create a general diagnosis
  2. Create a more specific diagnosis by adding up to 10 items
  3. Enter the follow-up time period
  4. Enter a description of the patients
  5. Enter the main statistic (main outcome measure)
  6. Enter the name of the author or authors

The next step will be to create a list of treatments. To go to the next page on the website, the Treatment Organizer™ page, you will click on the blue icon that says “Tx” which is an abbreviation for treatment.


Another tutorial follows which will explain how to use the Treatment Organizer™ page.

Remember, you are dealing with two websites. This website is the Treatment Scores Blog at:
http://TreatmentScoresBlog.com

The tools for creating Treatment Scores are at:
http://Treatment Scores.com

We are creating Treatment Scores at TreatmentScores.com and then we are blogging about them at TreatmentScoresBlog.com. Eventually, we will combine the two websites into one.

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