From 672fb3adee3c1618209b10854baf50dc8be7d77a Mon Sep 17 00:00:00 2001 From: Kyle Belanger Date: Tue, 20 Jun 2023 16:34:13 -0400 Subject: [PATCH] Update chapter5.qmd --- chapter5.qmd | 72 ++++++++++++++++++++++++++++++++-------------------- 1 file changed, 44 insertions(+), 28 deletions(-) diff --git a/chapter5.qmd b/chapter5.qmd index aab303d..c7528f1 100644 --- a/chapter5.qmd +++ b/chapter5.qmd @@ -5,6 +5,50 @@ progress ## Summary of Results +The findings of this study indicate that within another commonly ordered +laboratory testing, the diagnostic value of Free T4 can be predicted +accurately 80% of the time. While examining only the elevated TSH +results, the algorithm had a false positive rate of 2% and a false +negative rate of 16%. In the original data, 76% of the time, the result +was non-diagnostic for Hypo-Thryodism. For the decreased TSH results, +the algorithm had a false positive rate of 8% and a false negative rate +of 20%. In the original data, 67% of the time, the result was +non-diagnostic for Hyper-Thryodism. + +1846 - Hypo + +423 - Hyper + +9170 - High TSH (hypo) + +## Real World Applications + +While the current algorithm did not quite achieve an accuracy ready for +deployment, it is hypothesized that a system like this could be +implemented in clinical decision-making systems. As stated previously, +current practice is a physician (or other care providers) orders a TSH, +and if the value is outside laboratory-established reference ranges, the +Free T4 is added on. In the current study database, this reflex testing +was non-diagnostic 76% of the time for elevated TSH values and 67% for +decreased TSH values. Using clinical decision support first to predict +whether the Free T4 would be diagnostic, the care provider can use this +prediction and other patient signs and symptoms to determine if running +a Free T4 lab test is needed. + +Similarly to Luo et al., the idea that the diagnostic information +offered by Free T4 often duplicates what other diagnostic tests provide +suggests a notion of "informationally" redundant testing [-@luo2016]. It +is speculated that informationally redundant testing occurs in various +diagnostic settings and diagnostic workups. It is much more frequent +than the more traditionally defined and narrowly framed notion of +redundant testing, which most often includes unintended duplications of +the same or similar tests. Under this narrow definition, redundant +laboratory testing is estimated to waste more than \$5 billion annually +in the United States, potentially dwarfed by the waste from +informationally redundant testing [@luo2016]. However, since Free T4 and +all other tests used in this study are performed on automated +instruments, the cost savings to the lab and patient may be minimal. + ## Study Limitations Section overview - In progress @@ -51,31 +95,3 @@ more powerful algorithm ### Future Studies Explain how to fix these issues. - -## Real World Applications - -While the current algorithm did not quite achieve an accuracy ready for -deployment, it is hypothesized that a system like this could be -implemented in clinical decision-making systems. As stated previously, -current practice is a physician (or other care providers) orders a TSH, -and if the value is outside laboratory-established reference ranges, the -Free T4 is added on. In the current study database, this reflex testing -was non-diagnostic 76% of the time for elevated TSH values and 67% for -decreased TSH values. Using clinical decision support first to predict -whether the Free T4 would be diagnostic, the care provider can use this -prediction and other patient signs and symptoms to determine if running -a Free T4 lab test is needed. - -Similarly to Luo et al., the idea that the diagnostic information -offered by Free T4 often duplicates what other diagnostic tests provide -suggests a notion of "informationally" redundant testing [-@luo2016]. It -is speculated that informationally redundant testing occurs in various -diagnostic settings and diagnostic workups. It is much more frequent -than the more traditionally defined and narrowly framed notion of -redundant testing, which most often includes unintended duplications of -the same or similar tests. Under this narrow definition, redundant -laboratory testing is estimated to waste more than \$5 billion annually -in the United States, potentially dwarfed by the waste from -informationally redundant testing [@luo2016]. However, since Free T4 and -all other tests used in this study are performed on automated -instruments, the cost savings to the lab and patient may be minimal.