[Script Info]
Title: 
[Events]
Format: Layer, Start, End, Style, Name, MarginL, MarginR, MarginV, Effect, Text
Dialogue: 0,0:00:00.03,0:00:07.09,Default,,0000,0000,0000,,it's a rude awakening and mornig welcome\Nto do with the uh... third week of
Dialogue: 0,0:00:07.09,0:00:10.77,Default,,0000,0000,0000,,medical school for you you might have\Nnoticed that our
Dialogue: 0,0:00:10.77,0:00:13.68,Default,,0000,0000,0000,,cohort of medical students has that\Ndoubled
Dialogue: 0,0:00:13.68,0:00:17.08,Default,,0000,0000,0000,,in size if you guys have noticed you if\Nyou're here first of all the job finding
Dialogue: 0,0:00:17.08,0:00:19.08,Default,,0000,0000,0000,,this other lecture hall sorry work
Dialogue: 0,0:00:19.08,0:00:22.03,Default,,0000,0000,0000,,jumping you from place to place but this\Nis part of
Dialogue: 0,0:00:22.03,0:00:23.05,Default,,0000,0000,0000,,trying to revamp
Dialogue: 0,0:00:23.05,0:00:26.78,Default,,0000,0000,0000,,all of our lecture halls and so we had\Nto do this in a stage process those of
Dialogue: 0,0:00:26.78,0:00:28.53,Default,,0000,0000,0000,,you that understands gantt charts
Dialogue: 0,0:00:28.53,0:00:29.77,Default,,0000,0000,0000,,and construction
Dialogue: 0,0:00:29.77,0:00:32.05,Default,,0000,0000,0000,,will uh... will sympathize but you found\Nthe place
Dialogue: 0,0:00:32.05,0:00:35.69,Default,,0000,0000,0000,,in north lecture hall now are your\Ncolleagues here and suits
Dialogue: 0,0:00:35.69,0:00:39.02,Default,,0000,0000,0000,,they are a great source of advice
Dialogue: 0,0:00:39.02,0:00:44.06,Default,,0000,0000,0000,,and uh... and uh... being able to and\Nsort of queries about different staff so
Dialogue: 0,0:00:44.06,0:00:46.29,Default,,0000,0000,0000,,now you've got your built-in
Dialogue: 0,0:00:46.29,0:00:50.22,Default,,0000,0000,0000,,counselors uh... here but they're also\Ngoing to be very busy as you notice they
Dialogue: 0,0:00:50.22,0:00:54.01,Default,,0000,0000,0000,,probably probably noticed they started\Nabout an hour before you did so
Dialogue: 0,0:00:54.01,0:00:55.04,Default,,0000,0000,0000,,for
Dialogue: 0,0:00:55.04,0:00:57.47,Default,,0000,0000,0000,,that's what you have to look forward to\Nit here
Dialogue: 0,0:00:57.47,0:00:58.06,Default,,0000,0000,0000,,that that
Dialogue: 0,0:00:58.06,0:00:59.05,Default,,0000,0000,0000,,uh...
Dialogue: 0,0:00:59.05,0:01:04.02,Default,,0000,0000,0000,,hope you guys survived your first quiz\Nhopefully it wasn't too painful i know
Dialogue: 0,0:01:04.02,0:01:06.01,Default,,0000,0000,0000,,many people ask will they be medical\Ndecision making
Dialogue: 0,0:01:06.01,0:01:10.02,Default,,0000,0000,0000,,stuff on the quiz and the answer to that\Nwas
Dialogue: 0,0:01:10.02,0:01:11.02,Default,,0000,0000,0000,,uh...
Dialogue: 0,0:01:11.02,0:01:14.08,Default,,0000,0000,0000,,remember that genetics in pathology or\Nthe big components of the quizzes and
Dialogue: 0,0:01:14.08,0:01:18.09,Default,,0000,0000,0000,,that we in india and we have assignments\Nso you turned in your first assignment
Dialogue: 0,0:01:18.09,0:01:20.91,Default,,0000,0000,0000,,last thursday at small groups
Dialogue: 0,0:01:20.91,0:01:23.04,Default,,0000,0000,0000,,uh... i'm in the process of reviewing\Nthem
Dialogue: 0,0:01:23.04,0:01:25.09,Default,,0000,0000,0000,,they will get back to you in your mail\Nboxes
Dialogue: 0,0:01:25.09,0:01:28.07,Default,,0000,0000,0000,,uh... so you will be have them to study\Nfrom
Dialogue: 0,0:01:28.07,0:01:32.46,Default,,0000,0000,0000,,i will also when i return them to you\Nyou should pay attention on c_ tools all
Dialogue: 0,0:01:32.46,0:01:35.06,Default,,0000,0000,0000,,publisher ultimate which will also have\Nthe answer key
Dialogue: 0,0:01:35.06,0:01:37.42,Default,,0000,0000,0000,,to interview uh... assignments
Dialogue: 0,0:01:37.42,0:01:41.16,Default,,0000,0000,0000,,so there's no hidden doctors here it'll\Nbe a turkey will give you an explanation
Dialogue: 0,0:01:41.16,0:01:45.19,Default,,0000,0000,0000,,to each of the questions that way you\Ncan look at your answer what banter in
Dialogue: 0,0:01:45.19,0:01:47.00,Default,,0000,0000,0000,,turkey was any notes that you had
Dialogue: 0,0:01:47.00,0:01:48.91,Default,,0000,0000,0000,,and reconcile and if there are any
Dialogue: 0,0:01:48.91,0:01:52.30,Default,,0000,0000,0000,,other questions certainly we're here to\Nhelp you
Dialogue: 0,0:01:52.30,0:01:55.00,Default,,0000,0000,0000,,you have another small group tomorrow\Nafternoon
Dialogue: 0,0:01:55.00,0:01:58.02,Default,,0000,0000,0000,,that will largely be based on material\Nthat we cover today
Dialogue: 0,0:01:58.02,0:02:01.07,Default,,0000,0000,0000,,uh... hopefully if you guys have had a\Nchance to get a jump start on that i try
Dialogue: 0,0:02:01.07,0:02:03.01,Default,,0000,0000,0000,,to post in a week in advance
Dialogue: 0,0:02:03.01,0:02:04.55,Default,,0000,0000,0000,,you're more then welcome to
Dialogue: 0,0:02:04.55,0:02:08.01,Default,,0000,0000,0000,,uh... reading ahead is hopefully fine\Nencouraged if you want to do want to
Dialogue: 0,0:02:08.01,0:02:09.01,Default,,0000,0000,0000,,that's totally fine as well
Dialogue: 0,0:02:09.01,0:02:12.01,Default,,0000,0000,0000,,there should be enough time to be able\Nto complete that again it's the same
Dialogue: 0,0:02:12.01,0:02:12.94,Default,,0000,0000,0000,,protocol
Dialogue: 0,0:02:12.94,0:02:15.05,Default,,0000,0000,0000,,bring it to your small group still\Ndiscuss that with here
Dialogue: 0,0:02:15.05,0:02:18.99,Default,,0000,0000,0000,,co students in your small group silkair\Nand then returned them
Dialogue: 0,0:02:18.99,0:02:22.96,Default,,0000,0000,0000,,uh... tournament and then i'll be\Nreturning to you in a timely fashion
Dialogue: 0,0:02:22.96,0:02:29.06,Default,,0000,0000,0000,,any questions about the logistics of\Nthis course for this part of this force
Dialogue: 0,0:02:29.06,0:02:31.52,Default,,0000,0000,0000,,so why don't we go ahead and get started
Dialogue: 0,0:02:31.52,0:02:32.70,Default,,0000,0000,0000,,uh...
Dialogue: 0,0:02:32.70,0:02:35.93,Default,,0000,0000,0000,,today we're going to be for we're gonna\Nbe picking up a little bit where we left
Dialogue: 0,0:02:35.93,0:02:37.05,Default,,0000,0000,0000,,off
Dialogue: 0,0:02:37.05,0:02:38.07,Default,,0000,0000,0000,,last time
Dialogue: 0,0:02:38.07,0:02:42.09,Default,,0000,0000,0000,,and he wants start by declaring uh...\Nany industry relationships
Dialogue: 0,0:02:42.09,0:02:46.05,Default,,0000,0000,0000,,that i might add to contacts that meet\Nyour otherwise
Dialogue: 0,0:02:46.05,0:02:48.21,Default,,0000,0000,0000,,in the answer is
Dialogue: 0,0:02:48.21,0:02:50.57,Default,,0000,0000,0000,,certain factor
Dialogue: 0,0:02:50.57,0:02:52.46,Default,,0000,0000,0000,,uh... dancers is i have not been
Dialogue: 0,0:02:52.46,0:02:53.31,Default,,0000,0000,0000,,to disclose
Dialogue: 0,0:02:53.31,0:02:55.96,Default,,0000,0000,0000,,so nothing that would uh... interfere\Nwith my ability to present you an
Dialogue: 0,0:02:55.96,0:02:59.27,Default,,0000,0000,0000,,objective view of uh... medical decision\Nmade
Dialogue: 0,0:02:59.27,0:03:03.74,Default,,0000,0000,0000,,so our first just returning to where we\Nleft off with their first thread
Dialogue: 0,0:03:03.74,0:03:07.48,Default,,0000,0000,0000,,this is around information retrieval\Nfocusing on asking in acquiring
Dialogue: 0,0:03:07.48,0:03:09.17,Default,,0000,0000,0000,,if you remember and
Dialogue: 0,0:03:09.17,0:03:13.24,Default,,0000,0000,0000,,after last monday we left off by talking\Nabout the way the structure well
Dialogue: 0,0:03:13.24,0:03:16.22,Default,,0000,0000,0000,,foreground question and these are sort\Nof that
Dialogue: 0,0:03:16.22,0:03:18.79,Default,,0000,0000,0000,,uh... fundamental tools that were\Nrequired to
Dialogue: 0,0:03:18.79,0:03:22.51,Default,,0000,0000,0000,,af but good questions get the\Ninformation from the literature and then
Dialogue: 0,0:03:22.51,0:03:26.06,Default,,0000,0000,0000,,interpret and apply them as a way to\Nfocus a little bit just to revisit
Dialogue: 0,0:03:26.06,0:03:28.07,Default,,0000,0000,0000,,this tool that we talked about
Dialogue: 0,0:03:28.07,0:03:32.01,Default,,0000,0000,0000,,this was the pico tool that encourage\Nyou to just use it as a tool basically
Dialogue: 0,0:03:32.01,0:03:36.01,Default,,0000,0000,0000,,it's a way of specifying the different\Nelements in your question there will be
Dialogue: 0,0:03:36.01,0:03:36.91,Default,,0000,0000,0000,,important
Dialogue: 0,0:03:36.91,0:03:40.03,Default,,0000,0000,0000,,tour it ought to be able to sort out the\Nappropriate answers
Dialogue: 0,0:03:40.03,0:03:42.09,Default,,0000,0000,0000,,and we think it's important to be able\Nto do with in advance
Dialogue: 0,0:03:42.09,0:03:45.01,Default,,0000,0000,0000,,because by doing it in advance
Dialogue: 0,0:03:45.01,0:03:49.00,Default,,0000,0000,0000,,uh... you're really able to focus on\Nwhat you need and what your patients
Dialogue: 0,0:03:49.00,0:03:49.08,Default,,0000,0000,0000,,need
Dialogue: 0,0:03:49.08,0:03:54.09,Default,,0000,0000,0000,,so in order to practice doing this went\Nto ask you to do is to look at this case
Dialogue: 0,0:03:54.09,0:03:56.09,Default,,0000,0000,0000,,and practice with your partner
Dialogue: 0,0:03:56.09,0:03:58.24,Default,,0000,0000,0000,,jotting down the foreground
Dialogue: 0,0:03:58.24,0:04:00.85,Default,,0000,0000,0000,,uh... question so let me go over the\Ncase real briefly
Dialogue: 0,0:04:00.85,0:04:03.07,Default,,0000,0000,0000,,because we're gonna be using this uh...\Nmoving forward
Dialogue: 0,0:04:03.07,0:04:06.01,Default,,0000,0000,0000,,so this is now this is a forty\Ntwo-year-old woman
Dialogue: 0,0:04:06.01,0:04:09.56,Default,,0000,0000,0000,,who comes to her primary-care\Npractitioners office
Dialogue: 0,0:04:09.56,0:04:12.08,Default,,0000,0000,0000,,for follow-up of her diabetes and you're\Nthe medical student
Dialogue: 0,0:04:12.08,0:04:14.01,Default,,0000,0000,0000,,she's currently on libby ride
Dialogue: 0,0:04:14.01,0:04:16.61,Default,,0000,0000,0000,,ten milligrams twice daily
Dialogue: 0,0:04:16.61,0:04:19.94,Default,,0000,0000,0000,,however her blood sugars still stay\Nelevated despite being on that
Dialogue: 0,0:04:19.94,0:04:21.38,Default,,0000,0000,0000,,medication delivery right
Dialogue: 0,0:04:21.38,0:04:22.92,Default,,0000,0000,0000,,after you see this patient
Dialogue: 0,0:04:22.92,0:04:24.65,Default,,0000,0000,0000,,you're attending asked whether you think
Dialogue: 0,0:04:24.65,0:04:28.03,Default,,0000,0000,0000,,she should admit foreman to her regimen
Dialogue: 0,0:04:28.03,0:04:31.05,Default,,0000,0000,0000,,pretend like you know what would your\Nideas and pretend like you know what
Dialogue: 0,0:04:31.05,0:04:34.01,Default,,0000,0000,0000,,metformin is you may not but these are\Nboth
Dialogue: 0,0:04:34.01,0:04:36.06,Default,,0000,0000,0000,,uh... it is that we use in diabetes
Dialogue: 0,0:04:36.06,0:04:39.03,Default,,0000,0000,0000,,we'll be right is the sole final you\Nreact
Dialogue: 0,0:04:39.03,0:04:42.91,Default,,0000,0000,0000,,and metformin is uh... another agent\Nthat we use
Dialogue: 0,0:04:42.91,0:04:45.01,Default,,0000,0000,0000,,uh... packets dvd
Dialogue: 0,0:04:45.01,0:04:48.05,Default,,0000,0000,0000,,uh... and i cant really pronounce what\Nthat actually stands for it's a very
Dialogue: 0,0:04:48.05,0:04:50.03,Default,,0000,0000,0000,,difficult word to pronounce but
Dialogue: 0,0:04:50.03,0:04:54.01,Default,,0000,0000,0000,,suffice it to say good beer i can see\Nhis your um... insulin
Dialogue: 0,0:04:54.01,0:04:58.05,Default,,0000,0000,0000,,uh... usa secretion but metformin\Nimproves your sensitivity uh... to
Dialogue: 0,0:04:58.05,0:05:01.08,Default,,0000,0000,0000,,insulin is well or that your body makes
Dialogue: 0,0:05:01.08,0:05:03.05,Default,,0000,0000,0000,,so let's say you know all of that
Dialogue: 0,0:05:03.05,0:05:06.05,Default,,0000,0000,0000,,and the question i would ask you to do\Nis to start putting on
Dialogue: 0,0:05:06.05,0:05:09.09,Default,,0000,0000,0000,,your hat as if you were a clinician just\Nto get a sense of what
Dialogue: 0,0:05:09.09,0:05:13.29,Default,,0000,0000,0000,,these kind of foreground questions are\Nabout remember therefore important
Dialogue: 0,0:05:13.29,0:05:14.57,Default,,0000,0000,0000,,components
Dialogue: 0,0:05:14.57,0:05:17.93,Default,,0000,0000,0000,,for a foreground question you have to\Ndefine the patient population that
Dialogue: 0,0:05:17.93,0:05:19.03,Default,,0000,0000,0000,,you're interested in
Dialogue: 0,0:05:19.03,0:05:21.03,Default,,0000,0000,0000,,you have to define the intervention
Dialogue: 0,0:05:21.03,0:05:22.82,Default,,0000,0000,0000,,that you're interested in
Dialogue: 0,0:05:22.82,0:05:26.46,Default,,0000,0000,0000,,the comparison group that would be part\Nof the study that might help you answer
Dialogue: 0,0:05:26.46,0:05:28.01,Default,,0000,0000,0000,,the question andy outcomes of interest
Dialogue: 0,0:05:28.01,0:05:31.64,Default,,0000,0000,0000,,that you would be that you in your\Npatient would be interested in
Dialogue: 0,0:05:31.64,0:05:35.05,Default,,0000,0000,0000,,this will help you then scanned the\Nliterature to figure out what are the
Dialogue: 0,0:05:35.05,0:05:38.00,Default,,0000,0000,0000,,articles that would be most relevant
Dialogue: 0,0:05:38.00,0:05:39.85,Default,,0000,0000,0000,,for this particular case
Dialogue: 0,0:05:39.85,0:05:43.00,Default,,0000,0000,0000,,so i'd like you did it was turned your\Npartner and come up with one
Dialogue: 0,0:05:43.00,0:05:46.04,Default,,0000,0000,0000,,that would meet all four categories it's\Na fairly straightforward exercise but
Dialogue: 0,0:05:46.04,0:05:47.06,Default,,0000,0000,0000,,wanna make sure that you get
Dialogue: 0,0:05:47.06,0:05:50.07,Default,,0000,0000,0000,,such answer practice that's so spent a\Ncouple minutes doing that and we'll talk
Dialogue: 0,0:05:50.07,0:06:21.95,Default,,0000,0000,0000,,about it
Dialogue: 0,0:06:21.95,0:07:06.01,Default,,0000,0000,0000,,a
Dialogue: 0,0:07:06.01,0:07:09.01,Default,,0000,0000,0000,,okay three parking lot with remember\Nthat really
Dialogue: 0,0:07:09.01,0:07:11.07,Default,,0000,0000,0000,,nobody answers here because
Dialogue: 0,0:07:11.07,0:07:15.67,Default,,0000,0000,0000,,every single uh... every single answer\Nthat you would give each of the four
Dialogue: 0,0:07:15.67,0:07:18.04,Default,,0000,0000,0000,,different categories would have some\Ndebate around
Dialogue: 0,0:07:18.04,0:07:22.03,Default,,0000,0000,0000,,whether the article that you retrieved\Nwith those particular characteristics of
Dialogue: 0,0:07:22.03,0:07:23.04,Default,,0000,0000,0000,,the study population
Dialogue: 0,0:07:23.04,0:07:25.04,Default,,0000,0000,0000,,would actually help you answer your\Nquestion
Dialogue: 0,0:07:25.04,0:07:29.04,Default,,0000,0000,0000,,or not and the degree to which it would\Ndo that so let's just hear some of the
Dialogue: 0,0:07:29.04,0:07:33.04,Default,,0000,0000,0000,,questions what i'd like you to do is not\Nthe same like he was ex and i was
Dialogue: 0,0:07:33.04,0:07:34.06,Default,,0000,0000,0000,,uh... was why
Dialogue: 0,0:07:34.06,0:07:37.01,Default,,0000,0000,0000,,i'd like to see if you could stated in\Nthe form of a question one that would
Dialogue: 0,0:07:37.01,0:07:39.32,Default,,0000,0000,0000,,contain all four
Dialogue: 0,0:07:39.32,0:07:40.85,Default,,0000,0000,0000,,of those different components
Dialogue: 0,0:07:40.85,0:07:41.72,Default,,0000,0000,0000,,just a little hint
Dialogue: 0,0:07:41.72,0:07:45.08,Default,,0000,0000,0000,,i might ask something like this uh... on\None of the either the assignments
Dialogue: 0,0:07:45.08,0:07:46.08,Default,,0000,0000,0000,,or certainly
Dialogue: 0,0:07:46.08,0:07:52.10,Default,,0000,0000,0000,,while our final examination as well so\Nwho wants to take a stab at it
Dialogue: 0,0:07:52.10,0:07:54.95,Default,,0000,0000,0000,,them
Dialogue: 0,0:07:54.95,0:08:01.08,Default,,0000,0000,0000,,uh...
Dialogue: 0,0:08:01.08,0:08:04.20,Default,,0000,0000,0000,,okay great so here let me let me restate\Nthis
Dialogue: 0,0:08:04.20,0:08:05.08,Default,,0000,0000,0000,,in women with diabetes
Dialogue: 0,0:08:05.08,0:08:09.94,Default,,0000,0000,0000,,what is the effect of metformin plus\Nglider ride
Dialogue: 0,0:08:09.94,0:08:12.05,Default,,0000,0000,0000,,blood sugar levels compared to drive me\Nright along
Dialogue: 0,0:08:12.05,0:08:16.02,Default,,0000,0000,0000,,so let's see if we got all the before\Ncomponents in their is that patient was
Dialogue: 0,0:08:16.02,0:08:20.06,Default,,0000,0000,0000,,women with diabetes your intervention\Nwas metformin it would be right together
Dialogue: 0,0:08:20.06,0:08:22.06,Default,,0000,0000,0000,,versus delivery right alone in the\Noutcome you're interested in
Dialogue: 0,0:08:22.06,0:08:25.27,Default,,0000,0000,0000,,was improvement in her blood sugar\Nlevels okay
Dialogue: 0,0:08:25.27,0:08:28.34,Default,,0000,0000,0000,,so let's break that down the patient\Npopulation is that were women with
Dialogue: 0,0:08:28.34,0:08:30.08,Default,,0000,0000,0000,,diabetes was that it did anyone have\Nsomething different
Dialogue: 0,0:08:30.08,0:08:34.02,Default,,0000,0000,0000,,then women with diabetes here
Dialogue: 0,0:08:34.02,0:08:39.02,Default,,0000,0000,0000,,awesome al you specified in age cutoff\Nso women with diabetes over forty ok any
Dialogue: 0,0:08:39.02,0:08:39.76,Default,,0000,0000,0000,,other
Dialogue: 0,0:08:39.76,0:08:44.00,Default,,0000,0000,0000,,variabilities there
Dialogue: 0,0:08:44.00,0:08:48.00,Default,,0000,0000,0000,,asel na specifying gender so just all\Npatients with diabetes let's back up and
Dialogue: 0,0:08:48.00,0:08:48.97,Default,,0000,0000,0000,,think about that
Dialogue: 0,0:08:48.97,0:08:51.10,Default,,0000,0000,0000,,limelight it so that the question would\Nbe if we're to get an article
Dialogue: 0,0:08:51.10,0:08:53.00,Default,,0000,0000,0000,,that had
Dialogue: 0,0:08:53.00,0:08:54.09,Default,,0000,0000,0000,,all ahead men and women
Dialogue: 0,0:08:54.09,0:08:56.05,Default,,0000,0000,0000,,in the past study population
Dialogue: 0,0:08:56.05,0:08:59.06,Default,,0000,0000,0000,,would we say that's ok to extrapolate\Nthe results
Dialogue: 0,0:08:59.06,0:09:01.86,Default,,0000,0000,0000,,and then apply to this patient\Npopulation
Dialogue: 0,0:09:01.86,0:09:03.01,Default,,0000,0000,0000,,and so you said
Dialogue: 0,0:09:03.01,0:09:07.09,Default,,0000,0000,0000,,potentially that would be ok any reason\Nto think that verb rationale
Dialogue: 0,0:09:07.09,0:09:19.06,Default,,0000,0000,0000,,what goes through your mind as you're\Nmaking that call
Dialogue: 0,0:09:19.06,0:09:22.07,Default,,0000,0000,0000,,but the answer being that date one of\Nthe rationale might be fifty-year
Dialogue: 0,0:09:22.07,0:09:24.06,Default,,0000,0000,0000,,defined studies where you have
Dialogue: 0,0:09:24.06,0:09:26.06,Default,,0000,0000,0000,,both genders represented as opposed to
Dialogue: 0,0:09:26.06,0:09:30.03,Default,,0000,0000,0000,,one gender alone so that's one certainly\None consideration what might be another
Dialogue: 0,0:09:30.03,0:09:36.01,Default,,0000,0000,0000,,consideration you would use
Dialogue: 0,0:09:36.01,0:09:39.06,Default,,0000,0000,0000,,uh... so now you're talking you're\Ngetting even more specific saying
Dialogue: 0,0:09:39.06,0:09:40.65,Default,,0000,0000,0000,,impatience
Dialogue: 0,0:09:40.65,0:09:41.06,Default,,0000,0000,0000,,who are
Dialogue: 0,0:09:41.06,0:09:45.03,Default,,0000,0000,0000,,poorly controlled on good be ride with\Ndiabetes
Dialogue: 0,0:09:45.03,0:09:48.06,Default,,0000,0000,0000,,what about the comparison group purses\Nuh... verses the intervention so that we
Dialogue: 0,0:09:48.06,0:09:49.25,Default,,0000,0000,0000,,another
Dialogue: 0,0:09:49.25,0:09:50.05,Default,,0000,0000,0000,,shape that you would be there
Dialogue: 0,0:09:50.05,0:09:53.05,Default,,0000,0000,0000,,but that you might use backing up to the\Ngender issue
Dialogue: 0,0:09:53.05,0:09:56.02,Default,,0000,0000,0000,,the question i would ask you to ask and\Nwe ask this question all the time does
Dialogue: 0,0:09:56.02,0:09:59.04,Default,,0000,0000,0000,,the disease manifest differently or act\Ndifferently
Dialogue: 0,0:09:59.04,0:10:01.05,Default,,0000,0000,0000,,in one gender verses another
Dialogue: 0,0:10:01.05,0:10:03.10,Default,,0000,0000,0000,,does the disease manifest if really\Ninpatient over forty
Dialogue: 0,0:10:03.10,0:10:06.02,Default,,0000,0000,0000,,rice's those that might be younger than\Nforty
Dialogue: 0,0:10:06.02,0:10:09.00,Default,,0000,0000,0000,,those would be the questions that you\Nwould be asking yourself and remember
Dialogue: 0,0:10:09.00,0:10:12.04,Default,,0000,0000,0000,,you have to build some background\Nknowledge about this subject before
Dialogue: 0,0:10:12.04,0:10:14.06,Default,,0000,0000,0000,,being able to ask the most sophisticated
Dialogue: 0,0:10:14.06,0:10:15.09,Default,,0000,0000,0000,,foreground question
Dialogue: 0,0:10:15.09,0:10:18.04,Default,,0000,0000,0000,,i'm trying to know a little bit about\Nthe pathophysiology
Dialogue: 0,0:10:18.04,0:10:21.01,Default,,0000,0000,0000,,but it's reasonable to have those\Ndifferent want uh... those those
Dialogue: 0,0:10:21.01,0:10:23.24,Default,,0000,0000,0000,,different shades of variation
Dialogue: 0,0:10:23.24,0:10:24.04,Default,,0000,0000,0000,,in the patient
Dialogue: 0,0:10:24.04,0:10:27.02,Default,,0000,0000,0000,,the intervention was metformin plus\Nwe'll be right did anyone have a
Dialogue: 0,0:10:27.02,0:10:32.02,Default,,0000,0000,0000,,different intervention
Dialogue: 0,0:10:32.02,0:10:34.06,Default,,0000,0000,0000,,oddly be what we're thinking about the\Nkind that we're not talking about
Dialogue: 0,0:10:34.06,0:10:37.06,Default,,0000,0000,0000,,stopping the glitter ride and adding\Nmetformin
Dialogue: 0,0:10:37.06,0:10:40.05,Default,,0000,0000,0000,,but in some cases you might be looking\Nfor head to head comparison
Dialogue: 0,0:10:40.05,0:10:43.07,Default,,0000,0000,0000,,and in fact if you're thinking about it\Nfrom a drug company standpoint they may
Dialogue: 0,0:10:43.07,0:10:46.04,Default,,0000,0000,0000,,be interested in head to head\Ncomparisons because they're trying to
Dialogue: 0,0:10:46.04,0:10:47.53,Default,,0000,0000,0000,,prove one
Dialogue: 0,0:10:47.53,0:10:49.08,Default,,0000,0000,0000,,at the at the efficacy of one drug over\Nanother
Dialogue: 0,0:10:49.08,0:10:52.01,Default,,0000,0000,0000,,if you're thinking about it from the\Nstandpoint of
Dialogue: 0,0:10:52.01,0:10:55.04,Default,,0000,0000,0000,,of uh... pathophysiology you might be\Ninterested in head to head comparisons
Dialogue: 0,0:10:55.04,0:10:58.04,Default,,0000,0000,0000,,but if you're thinking about it in the\Npractical sense we often might be
Dialogue: 0,0:10:58.04,0:10:59.02,Default,,0000,0000,0000,,looking at
Dialogue: 0,0:10:59.02,0:11:02.05,Default,,0000,0000,0000,,adding and agent to an existing regimen
Dialogue: 0,0:11:02.05,0:11:04.41,Default,,0000,0000,0000,,those are less commonly found
Dialogue: 0,0:11:04.41,0:11:05.10,Default,,0000,0000,0000,,in the literature on just a tad
Dialogue: 0,0:11:05.10,0:11:09.03,Default,,0000,0000,0000,,and so you may be stuck saying well i\Ndon't have an additional
Dialogue: 0,0:11:09.03,0:11:12.05,Default,,0000,0000,0000,,uh... i don't have a study that shows\Nthe addition of metformin
Dialogue: 0,0:11:12.05,0:11:14.01,Default,,0000,0000,0000,,and so you would have to extrapolate
Dialogue: 0,0:11:14.01,0:11:15.39,Default,,0000,0000,0000,,from head to head comparison
Dialogue: 0,0:11:15.39,0:11:16.08,Default,,0000,0000,0000,,which is tricky did you
Dialogue: 0,0:11:16.08,0:11:19.01,Default,,0000,0000,0000,,certainly beyond the scope of this\Ncourse but keep in mind those of the
Dialogue: 0,0:11:19.01,0:11:22.08,Default,,0000,0000,0000,,questions that we entertain as positions\Nas for reading the literature
Dialogue: 0,0:11:22.08,0:11:26.06,Default,,0000,0000,0000,,now one of the outcomes that was was\Nmentioned was improvement in blood sugar
Dialogue: 0,0:11:26.06,0:11:32.04,Default,,0000,0000,0000,,so first of all how would we measure\Nthat
Dialogue: 0,0:11:32.04,0:11:34.33,Default,,0000,0000,0000,,but voz votes
Dialogue: 0,0:11:34.33,0:11:37.31,Default,,0000,0000,0000,,okay so you could be looking at that's\Nthe blood sugar which have been one
Dialogue: 0,0:11:37.31,0:11:40.08,Default,,0000,0000,0000,,marker of diabetes hemoglobin a one c\Nwhich alert next year
Dialogue: 0,0:11:40.08,0:11:45.01,Default,,0000,0000,0000,,is a eleven for a test that we get that\Nit looks at patients long-term control
Dialogue: 0,0:11:45.01,0:11:47.96,Default,,0000,0000,0000,,our blood sugar at least medium control\Nover the past three months
Dialogue: 0,0:11:47.96,0:11:49.05,Default,,0000,0000,0000,,so that be a good outcome
Dialogue: 0,0:11:49.05,0:11:53.02,Default,,0000,0000,0000,,to specify so you could get that level\Nof specificity and you might find
Dialogue: 0,0:11:53.02,0:11:57.37,Default,,0000,0000,0000,,studies that look at just after larger\Nverses does that look at a one c and you
Dialogue: 0,0:11:57.37,0:11:59.07,Default,,0000,0000,0000,,would have to decide which ones
Dialogue: 0,0:11:59.07,0:12:02.07,Default,,0000,0000,0000,,for me in my patient now would be\Nimportant consideration
Dialogue: 0,0:12:02.07,0:12:05.07,Default,,0000,0000,0000,,any other types of outcomes you guys\Nlooked at
Dialogue: 0,0:12:05.07,0:12:15.03,Default,,0000,0000,0000,,or anyone specified besides blood sugar\Nimprovement
Dialogue: 0,0:12:15.03,0:12:18.05,Default,,0000,0000,0000,,basil side effects might be another\Noutcome that you would look at what sort
Dialogue: 0,0:12:18.05,0:12:21.09,Default,,0000,0000,0000,,of side effects might be worth we'd be\Nworried about a few
Dialogue: 0,0:12:21.09,0:12:24.08,Default,,0000,0000,0000,,if you know any
Dialogue: 0,0:12:24.08,0:12:27.08,Default,,0000,0000,0000,,so one that i might be worried about is\Nwould i be dropping this patient's blood
Dialogue: 0,0:12:27.08,0:12:29.06,Default,,0000,0000,0000,,sugar too low
Dialogue: 0,0:12:29.06,0:12:31.03,Default,,0000,0000,0000,,to the point that they have hypoglycemic\Nevents
Dialogue: 0,0:12:31.03,0:12:32.10,Default,,0000,0000,0000,,so that would be something to be\Nthinking about
Dialogue: 0,0:12:32.10,0:12:37.03,Default,,0000,0000,0000,,but absolutely remember this is a\Ntherapeutic question that your asking
Dialogue: 0,0:12:37.03,0:12:40.10,Default,,0000,0000,0000,,and as if they're peter question there\Nare unintended or sometimes
Dialogue: 0,0:12:40.10,0:12:44.42,Default,,0000,0000,0000,,uh... known side effects of the\Ndifferent genes that we
Dialogue: 0,0:12:44.42,0:12:47.03,Default,,0000,0000,0000,,that we use and so looking at the\Nadverse events
Dialogue: 0,0:12:47.03,0:12:49.01,Default,,0000,0000,0000,,would be another important outcome
Dialogue: 0,0:12:49.01,0:12:52.01,Default,,0000,0000,0000,,so keep in mind this is just an exercise\Nbut to wall
Dialogue: 0,0:12:52.01,0:12:55.04,Default,,0000,0000,0000,,to get us to where we dot where we need\Nto go so that when we look at the
Dialogue: 0,0:12:55.04,0:12:56.00,Default,,0000,0000,0000,,literature
Dialogue: 0,0:12:56.00,0:12:57.50,Default,,0000,0000,0000,,we know what we're looking at
Dialogue: 0,0:12:57.50,0:12:59.07,Default,,0000,0000,0000,,that is the point of the foreground\Nquestion
Dialogue: 0,0:12:59.07,0:13:01.01,Default,,0000,0000,0000,,now this is up there
Dialogue: 0,0:13:01.01,0:13:03.95,Default,,0000,0000,0000,,foreground question before i questions\Nabout their feet
Dialogue: 0,0:13:03.95,0:13:07.46,Default,,0000,0000,0000,,later on in this lecture really talking\Nabout or run questions
Dialogue: 0,0:13:07.46,0:13:09.06,Default,,0000,0000,0000,,as it pertains to diagnostic tests
Dialogue: 0,0:13:09.06,0:13:12.37,Default,,0000,0000,0000,,again to get distinct types of questions
Dialogue: 0,0:13:12.37,0:13:16.98,Default,,0000,0000,0000,,but both equally important here a couple\Nof examples that we that were uh... that
Dialogue: 0,0:13:16.98,0:13:21.03,Default,,0000,0000,0000,,would be reasonable i think you guys\Ncame in kimba up with these in tight to
Dialogue: 0,0:13:21.03,0:13:23.10,Default,,0000,0000,0000,,die but if that was one thing we didn't\Ntalk about the fact that this woman
Dialogue: 0,0:13:23.10,0:13:25.09,Default,,0000,0000,0000,,is a tight to diabetic
Dialogue: 0,0:13:25.09,0:13:28.06,Default,,0000,0000,0000,,she may be insulin requiring more\Ninsulin
Dialogue: 0,0:13:28.06,0:13:32.00,Default,,0000,0000,0000,,resist uh... you know that we talk about\Nthat one person so i can fight one being
Dialogue: 0,0:13:32.00,0:13:33.01,Default,,0000,0000,0000,,autoimmune
Dialogue: 0,0:13:33.01,0:13:36.02,Default,,0000,0000,0000,,more likely to happen upon early onset
Dialogue: 0,0:13:36.02,0:13:37.01,Default,,0000,0000,0000,,tight too
Dialogue: 0,0:13:37.01,0:13:39.10,Default,,0000,0000,0000,,uh... not necessarily requiring insulin
Dialogue: 0,0:13:39.10,0:13:42.59,Default,,0000,0000,0000,,uh... and so you might want to\Ndistinguish that studies that you're
Dialogue: 0,0:13:42.59,0:13:43.07,Default,,0000,0000,0000,,looking at
Dialogue: 0,0:13:43.07,0:13:46.08,Default,,0000,0000,0000,,but then there's a question is metformin\Ngood write better than the bread alone
Dialogue: 0,0:13:46.08,0:13:49.08,Default,,0000,0000,0000,,in lower bucks ordered that was\Nsomething that you guys came up with and
Dialogue: 0,0:13:49.08,0:13:52.08,Default,,0000,0000,0000,,here's the side-effect question among\Nwomen with type two diabetes
Dialogue: 0,0:13:52.08,0:13:56.02,Default,,0000,0000,0000,,are there more instances of low blood\Nsugar of insufficient on both metformin
Dialogue: 0,0:13:56.02,0:13:57.07,Default,,0000,0000,0000,,it would be right
Dialogue: 0,0:13:57.07,0:13:59.04,Default,,0000,0000,0000,,when compared with we'll be right along
Dialogue: 0,0:13:59.04,0:14:02.07,Default,,0000,0000,0000,,so that you guys came up with this\Nfairly straightforward exercised but
Dialogue: 0,0:14:02.07,0:14:06.04,Default,,0000,0000,0000,,keep in mind level of specificity is\Nimportant because you're gonna be faced
Dialogue: 0,0:14:06.04,0:14:08.01,Default,,0000,0000,0000,,with a ton of different studies
Dialogue: 0,0:14:08.01,0:14:10.09,Default,,0000,0000,0000,,you're gonna have to work through to\Nfigure out which are the ones that are
Dialogue: 0,0:14:10.09,0:14:14.10,Default,,0000,0000,0000,,most relevant tumi and the patient that\Nyou're working with what are the
Dialogue: 0,0:14:14.10,0:14:17.05,Default,,0000,0000,0000,,important outcomes to that may be very\Ndifferent
Dialogue: 0,0:14:17.05,0:14:20.06,Default,,0000,0000,0000,,and the outcomes that you are interested\Nin and so it's important vehicle to
Dialogue: 0,0:14:20.06,0:14:23.05,Default,,0000,0000,0000,,specify that of prop yes
Dialogue: 0,0:14:23.05,0:14:25.38,Default,,0000,0000,0000,,went
Dialogue: 0,0:14:25.38,0:14:27.07,Default,,0000,0000,0000,,at
Dialogue: 0,0:14:27.07,0:14:31.90,Default,,0000,0000,0000,,so it literature doesn't exist uh...\Nwhat do you do that is probably
Dialogue: 0,0:14:31.90,0:14:35.03,Default,,0000,0000,0000,,uh... the hardest question we face as\Nclinicians
Dialogue: 0,0:14:35.03,0:14:38.01,Default,,0000,0000,0000,,there is a when i'm gonna ask you to i'm\Nnot gonna be able to answer that
Dialogue: 0,0:14:38.01,0:14:39.00,Default,,0000,0000,0000,,completely
Dialogue: 0,0:14:39.00,0:14:42.10,Default,,0000,0000,0000,,but as we build our course over the next\Nthree years what you're going to get a
Dialogue: 0,0:14:42.10,0:14:44.01,Default,,0000,0000,0000,,sense of
Dialogue: 0,0:14:44.01,0:14:46.08,Default,,0000,0000,0000,,is that there is a hierarchy of evidence
Dialogue: 0,0:14:46.08,0:14:48.03,Default,,0000,0000,0000,,meaning that as
Dialogue: 0,0:14:48.03,0:14:52.04,Default,,0000,0000,0000,,certain studies take on certain study\Ncharacteristics both in terms of how
Dialogue: 0,0:14:52.04,0:14:56.09,Default,,0000,0000,0000,,they're designed and how well their\Nimplemented the level of evidence that
Dialogue: 0,0:14:56.09,0:14:59.09,Default,,0000,0000,0000,,they provide become stronger or weaker
Dialogue: 0,0:14:59.09,0:15:03.03,Default,,0000,0000,0000,,and so it's not necessarily do i have
Dialogue: 0,0:15:03.03,0:15:05.01,Default,,0000,0000,0000,,is there no studies out there
Dialogue: 0,0:15:05.01,0:15:07.10,Default,,0000,0000,0000,,what are their studies out there that\Nare less well done and so what do i do
Dialogue: 0,0:15:07.10,0:15:08.09,Default,,0000,0000,0000,,with those
Dialogue: 0,0:15:08.09,0:15:10.09,Default,,0000,0000,0000,,compared to studies that are really well\Ndone
Dialogue: 0,0:15:10.09,0:15:14.06,Default,,0000,0000,0000,,keeping in mind that the studies that\Nare really well done are actually less
Dialogue: 0,0:15:14.06,0:15:15.90,Default,,0000,0000,0000,,frequently encounter
Dialogue: 0,0:15:15.90,0:15:19.08,Default,,0000,0000,0000,,and those studies that are not so well\Ndone or studies that are
Dialogue: 0,0:15:19.08,0:15:21.08,Default,,0000,0000,0000,,observation as opposed to control\Nclinical trials
Dialogue: 0,0:15:21.08,0:15:24.04,Default,,0000,0000,0000,,so the answer your question is i don't\Nhave the answer now but that is exactly
Dialogue: 0,0:15:24.04,0:15:26.01,Default,,0000,0000,0000,,going to be the point of the next three\Nyears
Dialogue: 0,0:15:26.01,0:15:29.07,Default,,0000,0000,0000,,what do you do when you're faced with a\Nquandary we're gonna try to party
Dialogue: 0,0:15:29.07,0:15:31.07,Default,,0000,0000,0000,,conceptual model that will on full
Dialogue: 0,0:15:31.07,0:15:35.00,Default,,0000,0000,0000,,that you'll get more comfortable
Dialogue: 0,0:15:35.00,0:15:38.07,Default,,0000,0000,0000,,there many sources the foreground\Nquestions these are the pics precise
Dialogue: 0,0:15:38.07,0:15:40.73,Default,,0000,0000,0000,,questions if you go to medline four
Dialogue: 0,0:15:40.73,0:15:43.09,Default,,0000,0000,0000,,or that you will go to a practice\Nguidelines or you'll use evidence-based
Dialogue: 0,0:15:43.09,0:15:46.14,Default,,0000,0000,0000,,databases and all of these sorts of
Dialogue: 0,0:15:46.14,0:15:48.01,Default,,0000,0000,0000,,of uh... of resources will be introduced\Nto you
Dialogue: 0,0:15:48.01,0:15:52.00,Default,,0000,0000,0000,,as we go through
Dialogue: 0,0:15:52.00,0:15:54.08,Default,,0000,0000,0000,,so building on those questions then
Dialogue: 0,0:15:54.08,0:15:58.88,Default,,0000,0000,0000,,we do need to then figure out what is\Nthe data that we're getting and how do
Dialogue: 0,0:15:58.88,0:15:59.09,Default,,0000,0000,0000,,we interpret
Dialogue: 0,0:15:59.09,0:16:03.15,Default,,0000,0000,0000,,and so as i mentioned therapy types of\Nquestions are
Dialogue: 0,0:16:03.15,0:16:04.09,Default,,0000,0000,0000,,are very important part
Dialogue: 0,0:16:04.09,0:16:07.02,Default,,0000,0000,0000,,of what we do is the nation's they seem\Nto be
Dialogue: 0,0:16:07.02,0:16:10.58,Default,,0000,0000,0000,,the most natural thing you would assume\Npositions do which is prescribed
Dialogue: 0,0:16:10.58,0:16:11.03,Default,,0000,0000,0000,,treatment
Dialogue: 0,0:16:11.03,0:16:12.09,Default,,0000,0000,0000,,and figure out whether it's
Dialogue: 0,0:16:12.09,0:16:14.04,Default,,0000,0000,0000,,making a difference or not
Dialogue: 0,0:16:14.04,0:16:17.09,Default,,0000,0000,0000,,however it is not the most fundamental\Nthing that we do in fact
Dialogue: 0,0:16:17.09,0:16:20.01,Default,,0000,0000,0000,,therapeutic questions are very\Nsophisticated questions
Dialogue: 0,0:16:20.01,0:16:24.24,Default,,0000,0000,0000,,that we actually don't cover much about\Ntheir pete this year
Dialogue: 0,0:16:24.24,0:16:27.08,Default,,0000,0000,0000,,we do it in your second year as you\Nstart tackling pathophysiology
Dialogue: 0,0:16:27.08,0:16:29.00,Default,,0000,0000,0000,,this year
Dialogue: 0,0:16:29.00,0:16:31.01,Default,,0000,0000,0000,,the question we want you to start\Nthinking about
Dialogue: 0,0:16:31.01,0:16:33.07,Default,,0000,0000,0000,,what is going on
Dialogue: 0,0:16:33.07,0:16:39.02,Default,,0000,0000,0000,,is that you all a g of why what i'm so\Nthe the clinical manifestations
Dialogue: 0,0:16:39.02,0:16:40.04,Default,,0000,0000,0000,,of the disease
Dialogue: 0,0:16:40.04,0:16:44.10,Default,,0000,0000,0000,,and so that really focuses on diagnostic\Nreasoning and diagnostic test and so
Dialogue: 0,0:16:44.10,0:16:49.04,Default,,0000,0000,0000,,we're gonna spend the rest of our time\Ntoday focusing on diagnostic tests
Dialogue: 0,0:16:49.04,0:16:52.09,Default,,0000,0000,0000,,so here are the learning objectives for\Nthe rest of today by the end by the end
Dialogue: 0,0:16:52.09,0:16:55.07,Default,,0000,0000,0000,,of this lecture and honestly by the end\Nof your small groups tomorrow because
Dialogue: 0,0:16:55.07,0:16:58.08,Default,,0000,0000,0000,,you're gonna have to work through these\Nconcepts in small groups it's gonna be
Dialogue: 0,0:16:58.08,0:17:00.03,Default,,0000,0000,0000,,mainly a superficial
Dialogue: 0,0:17:00.03,0:17:02.04,Default,,0000,0000,0000,,covering today of the concept
Dialogue: 0,0:17:02.04,0:17:05.03,Default,,0000,0000,0000,,and the diving into it with your simon\Nin small groups are really where the
Dialogue: 0,0:17:05.03,0:17:06.07,Default,,0000,0000,0000,,learnings going to happen
Dialogue: 0,0:17:06.07,0:17:08.100,Default,,0000,0000,0000,,but by the end of this series of\Nsessions
Dialogue: 0,0:17:08.100,0:17:10.01,Default,,0000,0000,0000,,you should be able to do some
Dialogue: 0,0:17:10.01,0:17:12.02,Default,,0000,0000,0000,,fairly basic diagnostic
Dialogue: 0,0:17:12.02,0:17:14.02,Default,,0000,0000,0000,,diagnostic question formulation
Dialogue: 0,0:17:14.02,0:17:17.34,Default,,0000,0000,0000,,you should be able to define and uh...\Ncalculate
Dialogue: 0,0:17:17.34,0:17:20.96,Default,,0000,0000,0000,,sensitivity specificities and the\Npredicted values for different
Dialogue: 0,0:17:20.96,0:17:24.06,Default,,0000,0000,0000,,diagnostic test for an introduce that\Nconcept you today and tomorrow
Dialogue: 0,0:17:24.06,0:17:27.05,Default,,0000,0000,0000,,and you should be able to explain how\Nrisk factor
Dialogue: 0,0:17:27.05,0:17:30.29,Default,,0000,0000,0000,,that god can thrive prior probabilities
Dialogue: 0,0:17:30.29,0:17:33.67,Default,,0000,0000,0000,,and how this concept relates to\Nprevalence
Dialogue: 0,0:17:33.67,0:17:37.75,Default,,0000,0000,0000,,and then finally you should be able to\Nmodify probabilities from test results
Dialogue: 0,0:17:37.75,0:17:39.01,Default,,0000,0000,0000,,through on number of different\Nmechanisms
Dialogue: 0,0:17:39.01,0:17:44.01,Default,,0000,0000,0000,,we introduce you to the concept obeys\Nprobabilistic reasoning as a way of
Dialogue: 0,0:17:44.01,0:17:46.04,Default,,0000,0000,0000,,modifying probabilities over time
Dialogue: 0,0:17:46.04,0:17:47.06,Default,,0000,0000,0000,,today we're gonna use
Dialogue: 0,0:17:47.06,0:17:51.04,Default,,0000,0000,0000,,to buy two tables which is a of more\Nstraightforward
Dialogue: 0,0:17:51.04,0:17:55.03,Default,,0000,0000,0000,,easy to conceptualize and visualize way\Nof modifying probabilities
Dialogue: 0,0:17:55.03,0:17:58.43,Default,,0000,0000,0000,,but you'll get more and more practice\Nwith using that keep in mind that it is
Dialogue: 0,0:17:58.43,0:18:03.01,Default,,0000,0000,0000,,just as good as base so these are\Npresented to you as you should be one
Dialogue: 0,0:18:03.01,0:18:07.05,Default,,0000,0000,0000,,over the other represented the u{\u1}s{\u0}\Nitems to put in your toolbox in portland
Dialogue: 0,0:18:07.05,0:18:07.06,Default,,0000,0000,0000,,out
Dialogue: 0,0:18:07.06,0:18:09.91,Default,,0000,0000,0000,,at different points when the need arises
Dialogue: 0,0:18:09.91,0:18:13.04,Default,,0000,0000,0000,,there also other tools that are\Navailable that will introduce to you one
Dialogue: 0,0:18:13.04,0:18:14.09,Default,,0000,0000,0000,,called likelihood ratios
Dialogue: 0,0:18:14.09,0:18:16.08,Default,,0000,0000,0000,,and you'll get a chance to practice\Nthese
Dialogue: 0,0:18:16.08,0:18:20.03,Default,,0000,0000,0000,,in your assignments and in your smokers
Dialogue: 0,0:18:20.03,0:18:24.07,Default,,0000,0000,0000,,so just like we had the odyssey as a\Ncase for introducing you to use
Dialogue: 0,0:18:24.07,0:18:29.01,Default,,0000,0000,0000,,probabilistic reasoning this time really\Nimmerse yourself in a clinical case and
Dialogue: 0,0:18:29.01,0:18:31.08,Default,,0000,0000,0000,,i want you to think about this again\Njust with uh...
Dialogue: 0,0:18:31.08,0:18:35.08,Default,,0000,0000,0000,,limited amount of knowledge you have\Nabout this condition of this disease
Dialogue: 0,0:18:35.08,0:18:37.03,Default,,0000,0000,0000,,whatever you have this fall
Dialogue: 0,0:18:37.03,0:18:40.06,Default,,0000,0000,0000,,but bring to bear your experience as we\Nwork through this case during the
Dialogue: 0,0:18:40.06,0:18:42.01,Default,,0000,0000,0000,,remaining a bit the remainder of this\Nlike
Dialogue: 0,0:18:42.01,0:18:45.04,Default,,0000,0000,0000,,so the cases is sixty year old man
Dialogue: 0,0:18:45.04,0:18:47.06,Default,,0000,0000,0000,,who does not have heart disease
Dialogue: 0,0:18:47.06,0:18:50.80,Default,,0000,0000,0000,,who presents with sudden onset of\Nshortness of breath
Dialogue: 0,0:18:50.80,0:18:53.00,Default,,0000,0000,0000,,dismissed is a term that we use
Dialogue: 0,0:18:53.00,0:18:56.10,Default,,0000,0000,0000,,so here is a politically description of\Nthe problem that you can see
Dialogue: 0,0:18:56.10,0:19:00.01,Default,,0000,0000,0000,,yesterday after he flew in from\Ncalifornia the day before
Dialogue: 0,0:19:00.01,0:19:03.09,Default,,0000,0000,0000,,he'll blokes suddenly in the middle of\Nthe night at three in the morning with
Dialogue: 0,0:19:03.09,0:19:05.09,Default,,0000,0000,0000,,sudden shortness of breath
Dialogue: 0,0:19:05.09,0:19:08.09,Default,,0000,0000,0000,,so we woke up gasping for air at three\Nin the morning
Dialogue: 0,0:19:08.09,0:19:10.01,Default,,0000,0000,0000,,and he tells you
Dialogue: 0,0:19:10.01,0:19:12.06,Default,,0000,0000,0000,,that you ask them one question which is
Dialogue: 0,0:19:12.06,0:19:16.08,Default,,0000,0000,0000,,well was it bad when you were lying down\Nand that's why you setup or was it worth
Dialogue: 0,0:19:16.08,0:19:19.07,Default,,0000,0000,0000,,when you or is it about the same\Nregardless of whether you're setting up
Dialogue: 0,0:19:19.07,0:19:20.01,Default,,0000,0000,0000,,ur lying down
Dialogue: 0,0:19:20.01,0:19:24.10,Default,,0000,0000,0000,,because the people maybe was worse than\Nusual you said you know what
Dialogue: 0,0:19:24.10,0:19:26.01,Default,,0000,0000,0000,,actually is it
Dialogue: 0,0:19:26.01,0:19:28.08,Default,,0000,0000,0000,,any different online down if i'm sitting\Nup
Dialogue: 0,0:19:28.08,0:19:30.00,Default,,0000,0000,0000,,i'm still
Dialogue: 0,0:19:30.00,0:19:33.04,Default,,0000,0000,0000,,feeling short of breath and it won't be\Nup in the middle of the night
Dialogue: 0,0:19:33.04,0:19:36.02,Default,,0000,0000,0000,,all right so that is your initial chief\Ncomplaint
Dialogue: 0,0:19:36.02,0:19:40.02,Default,,0000,0000,0000,,this is something that you'll get used\Nto uh... as you do your data uh...
Dialogue: 0,0:19:40.02,0:19:43.06,Default,,0000,0000,0000,,queries from uh... from patients at your\Ndata gathering
Dialogue: 0,0:19:43.06,0:19:44.05,Default,,0000,0000,0000,,from from different
Dialogue: 0,0:19:44.05,0:19:46.05,Default,,0000,0000,0000,,but you being a good clinician
Dialogue: 0,0:19:46.05,0:19:49.09,Default,,0000,0000,0000,,you start asking some follow-up\Nquestions just like a good clinician
Dialogue: 0,0:19:49.09,0:19:53.02,Default,,0000,0000,0000,,uh... or good mccain sort of building on\Nthe mechanic model that we introduce you
Dialogue: 0,0:19:53.02,0:19:54.05,Default,,0000,0000,0000,,to a week ago
Dialogue: 0,0:19:54.05,0:19:58.00,Default,,0000,0000,0000,,so you ask him what other symptoms were\Nyou feeling at the time
Dialogue: 0,0:19:58.00,0:20:02.01,Default,,0000,0000,0000,,now as you get more sophisticated you\Nwill be asking more specific questions
Dialogue: 0,0:20:02.01,0:20:02.08,Default,,0000,0000,0000,,right now
Dialogue: 0,0:20:02.08,0:20:05.02,Default,,0000,0000,0000,,sort of the about what i would expect
Dialogue: 0,0:20:05.02,0:20:08.02,Default,,0000,0000,0000,,and what seems to be able to do what\Nelse we feeling at the time
Dialogue: 0,0:20:08.02,0:20:10.08,Default,,0000,0000,0000,,well he says does not testing
Dialogue: 0,0:20:10.08,0:20:15.40,Default,,0000,0000,0000,,he doesn't have a leg pain he doesn't\Nnotice any swelling of his leg
Dialogue: 0,0:20:15.40,0:20:18.90,Default,,0000,0000,0000,,he says idea just come back from a long\Nplane ride he flew in from california
Dialogue: 0,0:20:18.90,0:20:21.07,Default,,0000,0000,0000,,solicit was about five hours
Dialogue: 0,0:20:21.07,0:20:23.07,Default,,0000,0000,0000,,nonstop
Dialogue: 0,0:20:23.07,0:20:27.07,Default,,0000,0000,0000,,and he's had no problems like this\Nbefore that he knows
Dialogue: 0,0:20:27.07,0:20:29.09,Default,,0000,0000,0000,,this shortness of breath
Dialogue: 0,0:20:29.09,0:20:34.00,Default,,0000,0000,0000,,he takes one aspirin every day and he\Ndoes a smoke a pack of cigarettes
Dialogue: 0,0:20:34.00,0:20:35.07,Default,,0000,0000,0000,,everyday
Dialogue: 0,0:20:35.07,0:20:38.67,Default,,0000,0000,0000,,so that's kind of the next phase of\Ndiagnostic
Dialogue: 0,0:20:38.67,0:20:41.02,Default,,0000,0000,0000,,intake
Dialogue: 0,0:20:41.02,0:20:45.01,Default,,0000,0000,0000,,so the question that faces all of us\Njust like the mechanic faces
Dialogue: 0,0:20:45.01,0:20:48.01,Default,,0000,0000,0000,,is to be able to build a differential\Ndiagnosis you remember me mentioning
Dialogue: 0,0:20:48.01,0:20:50.01,Default,,0000,0000,0000,,well we as clinicians
Dialogue: 0,0:20:50.01,0:20:52.04,Default,,0000,0000,0000,,still differential diagnoses all the\Ntime
Dialogue: 0,0:20:52.04,0:20:55.06,Default,,0000,0000,0000,,and basically differential diagnosis is\Na list
Dialogue: 0,0:20:55.06,0:20:59.93,Default,,0000,0000,0000,,of possibilities with associated likely\Nthat's with associated probabilities
Dialogue: 0,0:20:59.93,0:21:04.05,Default,,0000,0000,0000,,so as we mentioned last time if you can\Np of a particular condition you'd be
Dialogue: 0,0:21:04.05,0:21:06.01,Default,,0000,0000,0000,,saying that the likelihood that
Dialogue: 0,0:21:06.01,0:21:09.00,Default,,0000,0000,0000,,this particular condition is the reason\Nfor the shortness of breath
Dialogue: 0,0:21:09.00,0:21:11.10,Default,,0000,0000,0000,,is x percent that's how you would write\Nthat down
Dialogue: 0,0:21:11.10,0:21:16.17,Default,,0000,0000,0000,,and what you would do is you place it in\Ndescending order of likelihood and you
Dialogue: 0,0:21:16.17,0:21:18.00,Default,,0000,0000,0000,,would be talking about wine
Dialogue: 0,0:21:18.00,0:21:20.06,Default,,0000,0000,0000,,if you could get this
Dialogue: 0,0:21:20.06,0:21:21.80,Default,,0000,0000,0000,,conceptual approach
Dialogue: 0,0:21:21.80,0:21:24.05,Default,,0000,0000,0000,,jupe all your differential diagnoses
Dialogue: 0,0:21:24.05,0:21:27.04,Default,,0000,0000,0000,,you will do well in medicine because\Nthis is how we talk
Dialogue: 0,0:21:27.04,0:21:31.05,Default,,0000,0000,0000,,now we don't do it necessarily in such\Nmathematical discrete models
Dialogue: 0,0:21:31.05,0:21:34.08,Default,,0000,0000,0000,,is exactly what we talk when we talk\Nwith another position we like you know
Dialogue: 0,0:21:34.08,0:21:35.01,Default,,0000,0000,0000,,what
Dialogue: 0,0:21:35.01,0:21:39.17,Default,,0000,0000,0000,,i think this patient has colon cancer\Nit's definitely more likely that he's
Dialogue: 0,0:21:39.17,0:21:41.04,Default,,0000,0000,0000,,got colon cancer than he has hemorrhoids
Dialogue: 0,0:21:41.04,0:21:44.05,Default,,0000,0000,0000,,that's kind of how we speak in barely in\Nformal settings
Dialogue: 0,0:21:44.05,0:21:45.66,Default,,0000,0000,0000,,when we're discussing
Dialogue: 0,0:21:45.66,0:21:48.07,Default,,0000,0000,0000,,uh... the case uh... a particular\Npatients case in trying to understand it
Dialogue: 0,0:21:48.07,0:21:49.06,Default,,0000,0000,0000,,yala g
Dialogue: 0,0:21:49.06,0:21:52.05,Default,,0000,0000,0000,,what we're really doing though is that\Nwords generating a differential
Dialogue: 0,0:21:52.05,0:21:56.03,Default,,0000,0000,0000,,diagnosis and it is the regardless of\Nwhat field you're going to do
Dialogue: 0,0:21:56.03,0:21:58.06,Default,,0000,0000,0000,,you'll be doing this over and over again
Dialogue: 0,0:21:58.06,0:22:01.01,Default,,0000,0000,0000,,so you get to your first one today
Dialogue: 0,0:22:01.01,0:22:02.01,Default,,0000,0000,0000,,so now what i'd like you to do
Dialogue: 0,0:22:02.01,0:22:04.00,Default,,0000,0000,0000,,is think about
Dialogue: 0,0:22:04.00,0:22:08.01,Default,,0000,0000,0000,,what possibilities may be going on with\Nthis particular time
Dialogue: 0,0:22:08.01,0:22:12.09,Default,,0000,0000,0000,,talk it over with your partner list two\Nor three things that might be going on
Dialogue: 0,0:22:12.09,0:22:18.02,Default,,0000,0000,0000,,and i will talk about what i think might\Nbe going on
Dialogue: 0,0:22:18.02,0:23:17.01,Default,,0000,0000,0000,,e
Dialogue: 0,0:23:17.01,0:23:21.06,Default,,0000,0000,0000,,okay productive well on the five because\Nit's probably arctic every different
Dialogue: 0,0:23:21.06,0:23:22.06,Default,,0000,0000,0000,,about yourself
Dialogue: 0,0:23:22.06,0:23:24.01,Default,,0000,0000,0000,,at this stage that you're at
Dialogue: 0,0:23:24.01,0:23:25.09,Default,,0000,0000,0000,,but it's not wrong to try
Dialogue: 0,0:23:25.09,0:23:28.01,Default,,0000,0000,0000,,so let's just hear something you don't\Nhave to give me a probability or
Dialogue: 0,0:23:28.01,0:23:29.05,Default,,0000,0000,0000,,anything like that
Dialogue: 0,0:23:29.05,0:23:38.10,Default,,0000,0000,0000,,just give me some possibilities of what\Nmight be going on
Dialogue: 0,0:23:38.10,0:23:42.03,Default,,0000,0000,0000,,all materialism versus congestive heart\Nfailure okay so we've got pulmonary
Dialogue: 0,0:23:42.03,0:23:43.22,Default,,0000,0000,0000,,embolism
Dialogue: 0,0:23:43.22,0:23:45.68,Default,,0000,0000,0000,,congestive heart failure what else do we\Ngo
Dialogue: 0,0:23:45.68,0:23:50.10,Default,,0000,0000,0000,,sleep apnea okay great other things yeah
Dialogue: 0,0:23:50.10,0:23:54.03,Default,,0000,0000,0000,,guilty gear emphysema while you guys and\Nhe you've gone through medical school
Dialogue: 0,0:23:54.03,0:23:57.07,Default,,0000,0000,0000,,before these are great coverage is a\Ngreat differential diagnosis absolutely
Dialogue: 0,0:23:57.07,0:24:01.27,Default,,0000,0000,0000,,ep
Dialogue: 0,0:24:01.27,0:24:03.09,Default,,0000,0000,0000,,events
Dialogue: 0,0:24:03.09,0:24:07.08,Default,,0000,0000,0000,,hotbed i'd i didn't ask him about scuba\Ndiving and whether he had uh...
Dialogue: 0,0:24:07.08,0:24:10.04,Default,,0000,0000,0000,,at whether he had done that but\Ncertainly that would be a follow-up
Dialogue: 0,0:24:10.04,0:24:12.06,Default,,0000,0000,0000,,question that we would act
Dialogue: 0,0:24:12.06,0:24:15.03,Default,,0000,0000,0000,,these are these are great things now\Nlet's peace apart with these things me
Dialogue: 0,0:24:15.03,0:24:17.06,Default,,0000,0000,0000,,first of all what is a pulmonary\Nembolism
Dialogue: 0,0:24:17.06,0:24:20.02,Default,,0000,0000,0000,,which had pulmonary embolism you know\Nwhat it p{\u1}s{\u0}
Dialogue: 0,0:24:20.02,0:24:40.01,Default,,0000,0000,0000,,unexplained
Dialogue: 0,0:24:40.01,0:24:41.09,Default,,0000,0000,0000,,so o'clock in the long
Dialogue: 0,0:24:41.09,0:24:45.10,Default,,0000,0000,0000,,the person was sitting in mobile for a\Nperiod of time which allows rumbled sis
Dialogue: 0,0:24:45.10,0:24:50.03,Default,,0000,0000,0000,,to develop especially in the lower\Nextremities which can then migrate up
Dialogue: 0,0:24:50.03,0:24:51.09,Default,,0000,0000,0000,,and gets stuck in the long
Dialogue: 0,0:24:51.09,0:24:55.06,Default,,0000,0000,0000,,you stated that his shortness of breath\Nwith sudden and so you started unpack
Dialogue: 0,0:24:55.06,0:24:58.03,Default,,0000,0000,0000,,the whole concept of rationale and my\Nthinking that
Dialogue: 0,0:24:58.03,0:25:01.02,Default,,0000,0000,0000,,versus some of the other things because\Noften times when you get a p{\u1}e{\u0} it
Dialogue: 0,0:25:01.02,0:25:04.09,Default,,0000,0000,0000,,suddenly breaks off part of your of the\Nclock suddenly breaks off and goes into
Dialogue: 0,0:25:04.09,0:25:06.02,Default,,0000,0000,0000,,the pulmonary basketball
Dialogue: 0,0:25:06.02,0:25:09.39,Default,,0000,0000,0000,,now you'll understate you'll start\Ndeveloping the language around that but
Dialogue: 0,0:25:09.39,0:25:13.05,Default,,0000,0000,0000,,that's a great way to explain that you\Nalso mentioned congestive heart failure
Dialogue: 0,0:25:13.05,0:25:15.68,Default,,0000,0000,0000,,now what is congestive heart
Dialogue: 0,0:25:15.68,0:25:18.04,Default,,0000,0000,0000,,art which on the spot but i was a good\Ndifferential i'm coming back into our
Dialogue: 0,0:25:18.04,0:25:42.02,Default,,0000,0000,0000,,world seven you know
Dialogue: 0,0:25:42.02,0:25:46.07,Default,,0000,0000,0000,,all right so congestive heart failure\Nbeing basically eight at in enhanced
Dialogue: 0,0:25:46.07,0:25:49.01,Default,,0000,0000,0000,,pulmonary vascular
Dialogue: 0,0:25:49.01,0:25:51.05,Default,,0000,0000,0000,,in the palm area vascular system because
Dialogue: 0,0:25:51.05,0:25:53.08,Default,,0000,0000,0000,,the heart is not able to
Dialogue: 0,0:25:53.08,0:25:58.05,Default,,0000,0000,0000,,nearly as good injection of the blood\Nthrough the periphery and so things back
Dialogue: 0,0:25:58.05,0:26:01.16,Default,,0000,0000,0000,,up for a bride of the reasons either\Nthough
Dialogue: 0,0:26:01.16,0:26:04.00,Default,,0000,0000,0000,,orgasm pump is well it's two-step you\Ngot valvular leakage
Dialogue: 0,0:26:04.00,0:26:07.10,Default,,0000,0000,0000,,and it backs up into the pulmonary\Nvasculature you increase the pressure it
Dialogue: 0,0:26:07.10,0:26:12.05,Default,,0000,0000,0000,,you cause pulmonary edema which gives\Nyou offensive shortness of breath but as
Dialogue: 0,0:26:12.05,0:26:15.09,Default,,0000,0000,0000,,you mentioned oftentimes that'll be\Naccompanied by peripheral oedema because
Dialogue: 0,0:26:15.09,0:26:19.00,Default,,0000,0000,0000,,of the heart backs up from left\Nventricular failure right ventricular
Dialogue: 0,0:26:19.00,0:26:19.08,Default,,0000,0000,0000,,failure
Dialogue: 0,0:26:19.08,0:26:20.09,Default,,0000,0000,0000,,than you actually have
Dialogue: 0,0:26:20.09,0:26:22.67,Default,,0000,0000,0000,,summit denying your lower extremities
Dialogue: 0,0:26:22.67,0:26:26.05,Default,,0000,0000,0000,,she doesn't according to him we haven't\Ndone the examination you so that's the
Dialogue: 0,0:26:26.05,0:26:30.01,Default,,0000,0000,0000,,caveat here but that may be a reasonable\Nthing to come up with uh... to uh... to
Dialogue: 0,0:26:30.01,0:26:33.68,Default,,0000,0000,0000,,come up with in your differential and\Nyou put it lower because there were some
Dialogue: 0,0:26:33.68,0:26:35.91,Default,,0000,0000,0000,,aspects that weren't necessarily as
Dialogue: 0,0:26:35.91,0:26:38.06,Default,,0000,0000,0000,,consistent with that bag no's' right
Dialogue: 0,0:26:38.06,0:26:41.03,Default,,0000,0000,0000,,so that's a that's a great way to\Napproach the differential
Dialogue: 0,0:26:41.03,0:26:43.00,Default,,0000,0000,0000,,i would mention obstructive sleep apnea
Dialogue: 0,0:26:43.00,0:26:43.93,Default,,0000,0000,0000,,overhear yet
Dialogue: 0,0:26:43.93,0:26:46.07,Default,,0000,0000,0000,,what's obstructive sleep apnea might\Nlike that that here
Dialogue: 0,0:26:46.07,0:26:57.81,Default,,0000,0000,0000,,e
Dialogue: 0,0:26:57.81,0:27:00.08,Default,,0000,0000,0000,,pacbell now that site so what let me\Njust uh... unpack what you're saying
Dialogue: 0,0:27:00.08,0:27:01.45,Default,,0000,0000,0000,,there
Dialogue: 0,0:27:01.45,0:27:04.05,Default,,0000,0000,0000,,you're commenting on the fact that this\Nguy woke up in the middle of the night
Dialogue: 0,0:27:04.05,0:27:06.09,Default,,0000,0000,0000,,with shortness of breath now oftentimes\Npeople who
Dialogue: 0,0:27:06.09,0:27:09.06,Default,,0000,0000,0000,,have obstructive sleep apnea don't\Nactually wake up
Dialogue: 0,0:27:09.06,0:27:12.03,Default,,0000,0000,0000,,but they have apnea episodes which means\Nthat they
Dialogue: 0,0:27:12.03,0:27:13.43,Default,,0000,0000,0000,,stopped breathing
Dialogue: 0,0:27:13.43,0:27:17.04,Default,,0000,0000,0000,,for a period of time and sometimes i can\Ncause them to suddenly startle and wake
Dialogue: 0,0:27:17.04,0:27:20.00,Default,,0000,0000,0000,,up they don't necessarily wake up short\Nof breath but they can't
Dialogue: 0,0:27:20.00,0:27:23.06,Default,,0000,0000,0000,,absolutely until anyone that wakes up in\Nthe middle of the night
Dialogue: 0,0:27:23.06,0:27:25.06,Default,,0000,0000,0000,,i'm certainly thinking about sleep apnea
Dialogue: 0,0:27:25.06,0:27:29.37,Default,,0000,0000,0000,,it's probably one of the most under\Ndiagnosed conditions in this country
Dialogue: 0,0:27:29.37,0:27:32.77,Default,,0000,0000,0000,,i didn't know the reggie white died of\Nit but he certainly would be pat rescue
Dialogue: 0,0:27:32.77,0:27:34.84,Default,,0000,0000,0000,,uvic because people who have are
Dialogue: 0,0:27:34.84,0:27:37.05,Default,,0000,0000,0000,,uh... and i don't know how it will be c\Nwas but large
Dialogue: 0,0:27:37.05,0:27:41.06,Default,,0000,0000,0000,,body habit is certainly is a risk factor\Nfor obstructive sleep apnea
Dialogue: 0,0:27:41.06,0:27:45.43,Default,,0000,0000,0000,,also can lead to right sided congestive\Nheart failure so might also be connected
Dialogue: 0,0:27:45.43,0:27:47.06,Default,,0000,0000,0000,,to one of the diagnoses that we heard\Nearly on
Dialogue: 0,0:27:47.06,0:27:52.00,Default,,0000,0000,0000,,so keep in mind that sometimes diagnoses\Nare completely independent of themselves
Dialogue: 0,0:27:52.00,0:27:55.01,Default,,0000,0000,0000,,revelry talked about independent\Nindependent events
Dialogue: 0,0:27:55.01,0:27:58.30,Default,,0000,0000,0000,,sometimes different items in your\Ndifferential are actually related to
Dialogue: 0,0:27:58.30,0:28:02.00,Default,,0000,0000,0000,,other items that you differential so we\Nhave to keep that in mind as well
Dialogue: 0,0:28:02.00,0:28:05.01,Default,,0000,0000,0000,,by legal said feel p{\u1}d{\u0} in the back and\Nnow possible emphysema what is that
Dialogue: 0,0:28:05.01,0:28:07.08,Default,,0000,0000,0000,,and why might he be at risk for them
Dialogue: 0,0:28:07.08,0:28:28.66,Default,,0000,0000,0000,,front his
Dialogue: 0,0:28:28.66,0:28:29.09,Default,,0000,0000,0000,,baton so
Dialogue: 0,0:28:29.09,0:28:32.10,Default,,0000,0000,0000,,clearly he's got to look just to\Nreiterate what you're saying
Dialogue: 0,0:28:32.10,0:28:34.09,Default,,0000,0000,0000,,he's a smoker
Dialogue: 0,0:28:34.09,0:28:39.03,Default,,0000,0000,0000,,long-term smoking can cause destruction\Nand inflammation to the pulmonary
Dialogue: 0,0:28:39.03,0:28:40.01,Default,,0000,0000,0000,,bronchus tree
Dialogue: 0,0:28:40.01,0:28:42.03,Default,,0000,0000,0000,,andy alveolar
Dialogue: 0,0:28:42.03,0:28:45.03,Default,,0000,0000,0000,,uh... components of it what you learn\Nabout this year and next year
Dialogue: 0,0:28:45.03,0:28:49.00,Default,,0000,0000,0000,,uh... destruction of the albee ally is\Ntypically what we see as a mechanism
Dialogue: 0,0:28:49.00,0:28:50.04,Default,,0000,0000,0000,,towards emphysema
Dialogue: 0,0:28:50.04,0:28:55.05,Default,,0000,0000,0000,,which is one manifestation clinical\Nmanifestation of seo p{\u1}d{\u0} and certainly
Dialogue: 0,0:28:55.05,0:28:56.06,Default,,0000,0000,0000,,can impair oxygen
Dialogue: 0,0:28:56.06,0:28:59.08,Default,,0000,0000,0000,,exchange which would make you short of\Nbreath and destiny
Dialogue: 0,0:28:59.08,0:29:03.03,Default,,0000,0000,0000,,and maybe he's in the early stages maybe\Nthis is just his first manifestation of
Dialogue: 0,0:29:03.03,0:29:03.80,Default,,0000,0000,0000,,that
Dialogue: 0,0:29:03.80,0:29:06.02,Default,,0000,0000,0000,,you know he said he has ended for breath\Nbefore
Dialogue: 0,0:29:06.02,0:29:09.03,Default,,0000,0000,0000,,but your focusing on his rest
Dialogue: 0,0:29:09.03,0:29:10.08,Default,,0000,0000,0000,,dot keep that in mind
Dialogue: 0,0:29:10.08,0:29:14.04,Default,,0000,0000,0000,,some people were focusing on how he\Npresented waking up in the middle of the
Dialogue: 0,0:29:14.04,0:29:15.03,Default,,0000,0000,0000,,night
Dialogue: 0,0:29:15.03,0:29:17.08,Default,,0000,0000,0000,,some people are focusing on risk
Dialogue: 0,0:29:17.08,0:29:21.00,Default,,0000,0000,0000,,both are absolutely critical as you get\Nas you generate your differential
Dialogue: 0,0:29:21.00,0:29:21.10,Default,,0000,0000,0000,,diagnosis
Dialogue: 0,0:29:21.10,0:29:22.08,Default,,0000,0000,0000,,risk
Dialogue: 0,0:29:22.08,0:29:27.00,Default,,0000,0000,0000,,drives the order often of the things in\Nyour differential diagnosis
Dialogue: 0,0:29:27.00,0:29:28.56,Default,,0000,0000,0000,,but how u manifest
Dialogue: 0,0:29:28.56,0:29:31.01,Default,,0000,0000,0000,,also changes the order and what you're\Nthinking about
Dialogue: 0,0:29:31.01,0:29:33.04,Default,,0000,0000,0000,,in a different likeness
Dialogue: 0,0:29:33.04,0:29:35.07,Default,,0000,0000,0000,,both of the things that we need to walk\Nin with
Dialogue: 0,0:29:35.07,0:29:39.05,Default,,0000,0000,0000,,and as we think about observational\Nstudies tying this to what doctor grover
Dialogue: 0,0:29:39.05,0:29:41.02,Default,,0000,0000,0000,,was talking about last week
Dialogue: 0,0:29:41.02,0:29:44.93,Default,,0000,0000,0000,,observation als studies give us\Ninformation about race
Dialogue: 0,0:29:44.93,0:29:47.03,Default,,0000,0000,0000,,they give us information about risk\Nfactor
Dialogue: 0,0:29:47.03,0:29:50.01,Default,,0000,0000,0000,,that contribute to different clinical\Ncase uh... disorders
Dialogue: 0,0:29:50.01,0:29:53.43,Default,,0000,0000,0000,,so very important to trying title of\Nthis to get and question over here some
Dialogue: 0,0:29:53.43,0:29:56.07,Default,,0000,0000,0000,,yes
Dialogue: 0,0:29:56.07,0:30:00.04,Default,,0000,0000,0000,,back g{\u1}o{\u0}p_ d is chronic obstructive\Npulmonary disease
Dialogue: 0,0:30:00.04,0:30:04.02,Default,,0000,0000,0000,,it is the long-term manifestations of\Ntobacco use
Dialogue: 0,0:30:04.02,0:30:07.06,Default,,0000,0000,0000,,it can manifest through either emphysema\Nwhere you have destruction of the
Dialogue: 0,0:30:07.06,0:30:08.08,Default,,0000,0000,0000,,alveolar tissue
Dialogue: 0,0:30:08.08,0:30:11.00,Default,,0000,0000,0000,,and impaired oxygen exchange as a result
Dialogue: 0,0:30:11.00,0:30:14.18,Default,,0000,0000,0000,,you can also manifest as what we call\Nchronic bronchitis where you have a
Dialogue: 0,0:30:14.18,0:30:16.00,Default,,0000,0000,0000,,tremendous amount of inflammation
Dialogue: 0,0:30:16.00,0:30:20.05,Default,,0000,0000,0000,,in the broncos and with mucus production\Nwhich can also cause impaired oxygen
Dialogue: 0,0:30:20.05,0:30:21.03,Default,,0000,0000,0000,,i mean
Dialogue: 0,0:30:21.03,0:30:22.10,Default,,0000,0000,0000,,uh... oxygenation
Dialogue: 0,0:30:22.10,0:30:25.15,Default,,0000,0000,0000,,so sorry i didn't identified annual
Dialogue: 0,0:30:25.15,0:30:28.56,Default,,0000,0000,0000,,learn all of these concepts as you move\Non
Dialogue: 0,0:30:28.56,0:30:31.08,Default,,0000,0000,0000,,so you're doing a great job building\Nyour first differential diagnosis now
Dialogue: 0,0:30:31.08,0:30:33.04,Default,,0000,0000,0000,,the problem is is i also said
Dialogue: 0,0:30:33.04,0:30:36.08,Default,,0000,0000,0000,,we have to start assigning probabilities\Nto get to these different
Dialogue: 0,0:30:36.08,0:30:40.01,Default,,0000,0000,0000,,uh... clinical manifestations of just\Ngive you an idea of what my list was
Dialogue: 0,0:30:40.01,0:30:41.08,Default,,0000,0000,0000,,before we get started
Dialogue: 0,0:30:41.08,0:30:43.07,Default,,0000,0000,0000,,that's right
Dialogue: 0,0:30:43.07,0:30:45.01,Default,,0000,0000,0000,,congestive heart failure
Dialogue: 0,0:30:45.01,0:30:47.06,Default,,0000,0000,0000,,and that the amount exacerbate shin
Dialogue: 0,0:30:47.06,0:30:49.09,Default,,0000,0000,0000,,and i also thought about asthma which\Ncould be another
Dialogue: 0,0:30:49.09,0:30:53.27,Default,,0000,0000,0000,,different manifestation that is not\Nnecessarily smoking related
Dialogue: 0,0:30:53.27,0:30:56.75,Default,,0000,0000,0000,,but also uh... can contribute to airway\Ninflammation
Dialogue: 0,0:30:56.75,0:30:59.97,Default,,0000,0000,0000,,i didn't have obstructive sleep apnea in\Nmy differential that doesn't mean that
Dialogue: 0,0:30:59.97,0:31:01.59,Default,,0000,0000,0000,,it's wrong to put it there
Dialogue: 0,0:31:01.59,0:31:05.25,Default,,0000,0000,0000,,um... many people would and what you'll\Nfind is a different clinicians will
Dialogue: 0,0:31:05.25,0:31:09.42,Default,,0000,0000,0000,,bring their different behind the scenes\Nto their differential diagnosis
Dialogue: 0,0:31:09.42,0:31:12.00,Default,,0000,0000,0000,,of the question is what do you do when\Nthey're all these behind seas out there
Dialogue: 0,0:31:12.00,0:31:17.06,Default,,0000,0000,0000,,and how do we assign probabilities to\Nthe different uh... clinical
Dialogue: 0,0:31:17.06,0:31:19.55,Default,,0000,0000,0000,,uh... entities in your differential
Dialogue: 0,0:31:19.55,0:31:22.79,Default,,0000,0000,0000,,or sometimes we can do it by a gut\Nfeeling
Dialogue: 0,0:31:22.79,0:31:26.10,Default,,0000,0000,0000,,based on what we know about the disease\Nbased on what we know about the patient
Dialogue: 0,0:31:26.10,0:31:29.28,Default,,0000,0000,0000,,based on what we know about the for\Nrespects
Dialogue: 0,0:31:29.28,0:31:32.07,Default,,0000,0000,0000,,and so here's my gut feeling\Ndifferential diagnosis
Dialogue: 0,0:31:32.07,0:31:34.10,Default,,0000,0000,0000,,i put p{\u1}e{\u0} at the top
Dialogue: 0,0:31:34.10,0:31:36.66,Default,,0000,0000,0000,,i could see a jeff next
Dialogue: 0,0:31:36.66,0:31:40.01,Default,,0000,0000,0000,,at thirty uh... and i put emphysema\Nthirteen asthma fourth
Dialogue: 0,0:31:40.01,0:31:43.02,Default,,0000,0000,0000,,and i tried to make it all add up to a\Nhundred percent so it was nice to meet
Dialogue: 0,0:31:43.02,0:31:46.54,Default,,0000,0000,0000,,so i could forty thirty twenty ten
Dialogue: 0,0:31:46.54,0:31:49.05,Default,,0000,0000,0000,,there is at a right answer you don't\Nknow
Dialogue: 0,0:31:49.05,0:31:53.02,Default,,0000,0000,0000,,that's just my gut feeling but what it\Ndoes tell you is i didn't think that
Dialogue: 0,0:31:53.02,0:31:57.91,Default,,0000,0000,0000,,pete was so overwhelmingly likely and i\Nwould put that at seventy percent and
Dialogue: 0,0:31:57.91,0:31:59.04,Default,,0000,0000,0000,,everything else down at the bottom
Dialogue: 0,0:31:59.04,0:32:02.01,Default,,0000,0000,0000,,there may be clinical conditions where\Nyou do that but keep in mind that each
Dialogue: 0,0:32:02.01,0:32:04.01,Default,,0000,0000,0000,,one of these diagnosis
Dialogue: 0,0:32:04.01,0:32:05.07,Default,,0000,0000,0000,,had both its
Dialogue: 0,0:32:05.07,0:32:08.04,Default,,0000,0000,0000,,can uh... consistent features
Dialogue: 0,0:32:08.04,0:32:11.06,Default,,0000,0000,0000,,and something that we're just kind of\Natypical
Dialogue: 0,0:32:11.06,0:32:14.08,Default,,0000,0000,0000,,why wouldn't it be a p{\u1}e{\u0} well he said\Nhe didn't have a new leads well he'll
Dialogue: 0,0:32:14.08,0:32:18.01,Default,,0000,0000,0000,,appear on a plane ride for five hours\Nmost people don't get a d{\u1}d{\u0}t_
Dialogue: 0,0:32:18.01,0:32:19.50,Default,,0000,0000,0000,,well maybe ever
Dialogue: 0,0:32:19.50,0:32:20.09,Default,,0000,0000,0000,,symbol that looks like
Dialogue: 0,0:32:20.09,0:32:23.31,Default,,0000,0000,0000,,y c h f not bad
Dialogue: 0,0:32:23.31,0:32:25.05,Default,,0000,0000,0000,,because there's you know there's some\Nthings that are consistent with a but he
Dialogue: 0,0:32:25.05,0:32:27.04,Default,,0000,0000,0000,,doesn't have flirts from any of you
Dialogue: 0,0:32:27.04,0:32:29.08,Default,,0000,0000,0000,,until their fingers that will sort of\Nmake you head
Dialogue: 0,0:32:29.08,0:32:31.09,Default,,0000,0000,0000,,and these numbers are part of making
Dialogue: 0,0:32:31.09,0:32:34.54,Default,,0000,0000,0000,,are are my manifestation of making
Dialogue: 0,0:32:34.54,0:32:37.67,Default,,0000,0000,0000,,uh... contribute communicating the head
Dialogue: 0,0:32:37.67,0:32:40.01,Default,,0000,0000,0000,,there a couple of other things you can\Ndo with this
Dialogue: 0,0:32:40.01,0:32:42.01,Default,,0000,0000,0000,,so for example remember
Dialogue: 0,0:32:42.01,0:32:44.10,Default,,0000,0000,0000,,you can combine probabilities of\Ndifferent events
Dialogue: 0,0:32:44.10,0:32:49.02,Default,,0000,0000,0000,,so what is the probability that\Nshortness of breath is due to be there p
Dialogue: 0,0:32:49.02,0:32:51.01,Default,,0000,0000,0000,,foresee a chap
Dialogue: 0,0:32:51.01,0:32:55.09,Default,,0000,0000,0000,,given these a particular numbers when\Nyou guys think
Dialogue: 0,0:32:55.09,0:33:02.15,Default,,0000,0000,0000,,seventy percent
Dialogue: 0,0:33:02.15,0:33:05.67,Default,,0000,0000,0000,,if the two are mutually independent\Nevents
Dialogue: 0,0:33:05.67,0:33:08.05,Default,,0000,0000,0000,,meaning that they're not dependent on\Neach other not meaning that if you happy
Dialogue: 0,0:33:08.05,0:33:10.66,Default,,0000,0000,0000,,you are not more likely to get seja
Dialogue: 0,0:33:10.66,0:33:11.06,Default,,0000,0000,0000,,or vice versa
Dialogue: 0,0:33:11.06,0:33:14.02,Default,,0000,0000,0000,,because if there is that overlap remote\Nfrom what we understand about the
Dialogue: 0,0:33:14.02,0:33:17.06,Default,,0000,0000,0000,,disease and you can't combine them by\Nadding so yes the answer to that would
Dialogue: 0,0:33:17.06,0:33:21.04,Default,,0000,0000,0000,,be seventy percent but remember a thing\Nin mind that provided that both don't
Dialogue: 0,0:33:21.04,0:33:22.10,Default,,0000,0000,0000,,happen simultaneously
Dialogue: 0,0:33:22.10,0:33:26.00,Default,,0000,0000,0000,,just as an intellectual exercise if you\Nthought that there might be a ten
Dialogue: 0,0:33:26.00,0:33:27.06,Default,,0000,0000,0000,,percent overlap
Dialogue: 0,0:33:27.06,0:33:32.09,Default,,0000,0000,0000,,in the likelihood that you have both p n\Nc h f bowing out of the same time
Dialogue: 0,0:33:32.09,0:33:35.01,Default,,0000,0000,0000,,meaning that they are dependent and then\Nsport
Dialogue: 0,0:33:35.01,0:33:36.62,Default,,0000,0000,0000,,that they're both likely
Dialogue: 0,0:33:36.62,0:33:39.39,Default,,0000,0000,0000,,uh... the it's possible that you're\Nhaving both of them happen at the same
Dialogue: 0,0:33:39.39,0:33:43.00,Default,,0000,0000,0000,,time then that you could combine the two\Nby saying what is the likelihood that
Dialogue: 0,0:33:43.00,0:33:45.09,Default,,0000,0000,0000,,you have either p or c h f
Dialogue: 0,0:33:45.09,0:33:47.04,Default,,0000,0000,0000,,but it wouldn't be seventy percent
Dialogue: 0,0:33:47.04,0:33:50.07,Default,,0000,0000,0000,,would actually be sixty percent because\Nthere's also ten percent chance
Dialogue: 0,0:33:50.07,0:33:53.00,Default,,0000,0000,0000,,but both are happy happening\Nsimultaneously
Dialogue: 0,0:33:53.00,0:33:56.06,Default,,0000,0000,0000,,but the good intellectual exercise to go\Nthrough again the numbers art as
Dialogue: 0,0:33:56.06,0:33:59.40,Default,,0000,0000,0000,,important as the concept that it goes\Ndown
Dialogue: 0,0:33:59.40,0:34:01.00,Default,,0000,0000,0000,,when but to events for depend
Dialogue: 0,0:34:01.00,0:34:03.02,Default,,0000,0000,0000,,keep in mind that in medicine
Dialogue: 0,0:34:03.02,0:34:05.10,Default,,0000,0000,0000,,their are absolutely independent events
Dialogue: 0,0:34:05.10,0:34:08.13,Default,,0000,0000,0000,,and their absolutely
Dialogue: 0,0:34:08.13,0:34:11.91,Default,,0000,0000,0000,,that will be dependent and has you go\Nthrough your blocks and understand the
Dialogue: 0,0:34:11.91,0:34:13.79,Default,,0000,0000,0000,,diseases you'll get an appreciation
Dialogue: 0,0:34:13.79,0:34:18.80,Default,,0000,0000,0000,,berwyn things are determined and when\Nthey read
Dialogue: 0,0:34:18.80,0:34:21.10,Default,,0000,0000,0000,,so basically what we're doing is worth\Nactually creating
Dialogue: 0,0:34:21.10,0:34:23.66,Default,,0000,0000,0000,,prior probability
Dialogue: 0,0:34:23.66,0:34:27.47,Default,,0000,0000,0000,,before we have done any further down the\Ntrack gathering with this patient
Dialogue: 0,0:34:27.47,0:34:29.06,Default,,0000,0000,0000,,re-affirm a couple of questions that we\Nwould ask
Dialogue: 0,0:34:29.06,0:34:33.00,Default,,0000,0000,0000,,well before we do any further exit we\Ncan do the physical exam yet
Dialogue: 0,0:34:33.00,0:34:36.03,Default,,0000,0000,0000,,we didn't do any real specific\Nquestioning within the week testing yet
Dialogue: 0,0:34:36.03,0:34:37.37,Default,,0000,0000,0000,,we're generating
Dialogue: 0,0:34:37.37,0:34:41.28,Default,,0000,0000,0000,,it prior probability remember we did\Nthat with the woman with the b{\u1}r{\u0}c_ a
Dialogue: 0,0:34:41.28,0:34:43.10,Default,,0000,0000,0000,,haitian that we were concerned about
Dialogue: 0,0:34:43.10,0:34:45.73,Default,,0000,0000,0000,,we had a prior probability with her\Nwalking in
Dialogue: 0,0:34:45.73,0:34:47.37,Default,,0000,0000,0000,,do when she was twenty years old
Dialogue: 0,0:34:47.37,0:34:50.00,Default,,0000,0000,0000,,well this is a prior probability that's\Nbased on a number of different factors
Dialogue: 0,0:34:50.00,0:34:52.79,Default,,0000,0000,0000,,that i doubt that i mentioned
Dialogue: 0,0:34:52.79,0:34:56.01,Default,,0000,0000,0000,,on the other hand you can actually\Ngenerated prior probability
Dialogue: 0,0:34:56.01,0:35:00.03,Default,,0000,0000,0000,,using some tools that are out there is\Nwhat don't want to demonstrate obscene
Dialogue: 0,0:35:00.03,0:35:03.67,Default,,0000,0000,0000,,as some of the tools that might be\Nhelpful to you
Dialogue: 0,0:35:03.67,0:35:07.08,Default,,0000,0000,0000,,so why is there are these things called\Nclinical prediction rules
Dialogue: 0,0:35:07.08,0:35:12.01,Default,,0000,0000,0000,,mechanical production rules are ways of\Nusing the literature and what we know
Dialogue: 0,0:35:12.01,0:35:15.03,Default,,0000,0000,0000,,about the literature estimate s
Dialogue: 0,0:35:15.03,0:35:17.66,Default,,0000,0000,0000,,about particular disease
Dialogue: 0,0:35:17.66,0:35:18.71,Default,,0000,0000,0000,,and
Dialogue: 0,0:35:18.71,0:35:23.12,Default,,0000,0000,0000,,the uh... the way that we did there are\Na number of them that are out there
Dialogue: 0,0:35:23.12,0:35:26.97,Default,,0000,0000,0000,,pulmonary embolism is one of those\Nclinical diseases that actually has a
Dialogue: 0,0:35:26.97,0:35:29.58,Default,,0000,0000,0000,,number of different political\Npredictions and i want to sort of show
Dialogue: 0,0:35:29.58,0:35:30.03,Default,,0000,0000,0000,,you
Dialogue: 0,0:35:30.03,0:35:33.27,Default,,0000,0000,0000,,what uh... what one uh... looks like
Dialogue: 0,0:35:33.27,0:35:36.84,Default,,0000,0000,0000,,so what you have here to really think\Nthat your slides that you can use as
Dialogue: 0,0:35:36.84,0:35:37.04,Default,,0000,0000,0000,,well
Dialogue: 0,0:35:37.04,0:35:39.60,Default,,0000,0000,0000,,this is mad calc three counts
Dialogue: 0,0:35:39.60,0:35:42.96,Default,,0000,0000,0000,,this is on the uh... you guys have\Naccess to this and uh... they're unknown
Dialogue: 0,0:35:42.96,0:35:44.00,Default,,0000,0000,0000,,bura different uh...
Dialogue: 0,0:35:44.00,0:35:47.24,Default,,0000,0000,0000,,their number of different medical\Ncalculators here
Dialogue: 0,0:35:47.24,0:35:50.09,Default,,0000,0000,0000,,for p what you would do is you would\Nenter in the day the for the particular
Dialogue: 0,0:35:50.09,0:35:51.89,Default,,0000,0000,0000,,patient
Dialogue: 0,0:35:51.89,0:35:57.41,Default,,0000,0000,0000,,and then it would give you step here in\Nthe lower right hand corner cc
Dialogue: 0,0:35:57.41,0:36:00.77,Default,,0000,0000,0000,,so let's do that for this particular\Ncase
Dialogue: 0,0:36:00.77,0:36:02.65,Default,,0000,0000,0000,,based on what we know right now
Dialogue: 0,0:36:02.65,0:36:07.58,Default,,0000,0000,0000,,based on what we were going out the\Nsixties right so we put the sixties
Dialogue: 0,0:36:07.58,0:36:09.01,Default,,0000,0000,0000,,we also know that he's made
Dialogue: 0,0:36:09.01,0:36:10.61,Default,,0000,0000,0000,,so we put that
Dialogue: 0,0:36:10.61,0:36:14.39,Default,,0000,0000,0000,,and then you'll see a whole series of\Nrisk factors here
Dialogue: 0,0:36:14.39,0:36:18.82,Default,,0000,0000,0000,,let's say we don't deal with uh... let's\Ngo down and see what he has
Dialogue: 0,0:36:18.82,0:36:22.59,Default,,0000,0000,0000,,we know he's got the acute onset which\Nmeans some that's another
Dialogue: 0,0:36:22.59,0:36:23.07,Default,,0000,0000,0000,,word that you learn
Dialogue: 0,0:36:23.07,0:36:25.58,Default,,0000,0000,0000,,sudden onset of this issue
Dialogue: 0,0:36:25.58,0:36:26.76,Default,,0000,0000,0000,,we click on that
Dialogue: 0,0:36:26.76,0:36:30.40,Default,,0000,0000,0000,,notice what's happening to the risk as\Nwe go through this
Dialogue: 0,0:36:30.40,0:36:33.89,Default,,0000,0000,0000,,just being sixty years old and mail
Dialogue: 0,0:36:33.89,0:36:36.65,Default,,0000,0000,0000,,and then adding acute onset of dyspnea
Dialogue: 0,0:36:36.65,0:36:39.75,Default,,0000,0000,0000,,this risk number goes up to fifty\Npercent
Dialogue: 0,0:36:39.75,0:36:42.33,Default,,0000,0000,0000,,really jumps up there
Dialogue: 0,0:36:42.33,0:36:46.02,Default,,0000,0000,0000,,and if we added that he might have been\Nimmobilized with saying this
Dialogue: 0,0:36:46.02,0:36:47.66,Default,,0000,0000,0000,,let's say he sat
Dialogue: 0,0:36:47.66,0:36:48.07,Default,,0000,0000,0000,,in a plane
Dialogue: 0,0:36:48.07,0:36:52.23,Default,,0000,0000,0000,,completely comatose for five hours\Ndidn't move out what
Dialogue: 0,0:36:52.23,0:36:56.42,Default,,0000,0000,0000,,that would probably qualify as\Nimmobilization
Dialogue: 0,0:36:56.42,0:36:58.26,Default,,0000,0000,0000,,let's say we clicked that
Dialogue: 0,0:36:58.26,0:37:02.08,Default,,0000,0000,0000,,you'll see that his risk of having a\Np{\u1}e{\u0} with all of this
Dialogue: 0,0:37:02.08,0:37:04.28,Default,,0000,0000,0000,,is now sixty percent
Dialogue: 0,0:37:04.28,0:37:07.25,Default,,0000,0000,0000,,so my gut feeling of forty percent
Dialogue: 0,0:37:07.25,0:37:11.84,Default,,0000,0000,0000,,probably and underestimation now this is\Na gut feeling this is based on
Dialogue: 0,0:37:11.84,0:37:15.07,Default,,0000,0000,0000,,spa operational stocks that are out\Nthere and putting them into a
Dialogue: 0,0:37:15.07,0:37:16.51,Default,,0000,0000,0000,,mathematical model
Dialogue: 0,0:37:16.51,0:37:19.01,Default,,0000,0000,0000,,you can get these things for your\Nhandheld device
Dialogue: 0,0:37:19.01,0:37:21.10,Default,,0000,0000,0000,,you can put them on the web a lot of\Nthese are being integrated into the
Dialogue: 0,0:37:21.10,0:37:24.00,Default,,0000,0000,0000,,electronic health record for positions
Dialogue: 0,0:37:24.00,0:37:24.99,Default,,0000,0000,0000,,so that these
Dialogue: 0,0:37:24.99,0:37:28.19,Default,,0000,0000,0000,,guides can be placed right at the point\Nof care
Dialogue: 0,0:37:28.19,0:37:31.32,Default,,0000,0000,0000,,i'd encourage you to think about these\Nand try to explore some of these because
Dialogue: 0,0:37:31.32,0:37:34.05,Default,,0000,0000,0000,,they were a number of these for a number\Nof different conditions out there
Dialogue: 0,0:37:34.05,0:37:37.05,Default,,0000,0000,0000,,but we're gonna return to this as we go\Nthrough so right now
Dialogue: 0,0:37:37.05,0:37:39.10,Default,,0000,0000,0000,,we're starting around sixty percent
Dialogue: 0,0:37:39.10,0:37:42.05,Default,,0000,0000,0000,,as our prior probability
Dialogue: 0,0:37:42.05,0:37:44.09,Default,,0000,0000,0000,,but you realize also that there's a\Nnumber of questions here that we just
Dialogue: 0,0:37:44.09,0:37:48.75,Default,,0000,0000,0000,,don't know the answer to the right legal\Nfees at a fever we don't know we know
Dialogue: 0,0:37:48.75,0:37:51.01,Default,,0000,0000,0000,,that he doesn't have a history very\Nvascular disease
Dialogue: 0,0:37:51.01,0:37:54.04,Default,,0000,0000,0000,,we don't know if he passed out we don't\Nknow if he's actually got one-sided
Dialogue: 0,0:37:54.04,0:37:55.05,Default,,0000,0000,0000,,lights while
Dialogue: 0,0:37:55.05,0:37:57.87,Default,,0000,0000,0000,,so there's more data we need to get
Dialogue: 0,0:37:57.87,0:37:59.54,Default,,0000,0000,0000,,so let's gather
Dialogue: 0,0:37:59.54,0:38:05.17,Default,,0000,0000,0000,,so more date
Dialogue: 0,0:38:05.17,0:38:08.06,Default,,0000,0000,0000,,so here's some more information then i'm\Ngonna throw at you based on this
Dialogue: 0,0:38:08.06,0:38:09.62,Default,,0000,0000,0000,,particular case
Dialogue: 0,0:38:09.62,0:38:13.17,Default,,0000,0000,0000,,you talk about family history find out\Nthat he actually
Dialogue: 0,0:38:13.17,0:38:14.60,Default,,0000,0000,0000,,has had
Dialogue: 0,0:38:14.60,0:38:19.15,Default,,0000,0000,0000,,he has a family that is that the d{\u1}d{\u0}t_\Nin the past
Dialogue: 0,0:38:19.15,0:38:22.70,Default,,0000,0000,0000,,pretty for it
Dialogue: 0,0:38:22.70,0:38:26.06,Default,,0000,0000,0000,,you do a physical exam on him and you\Nfind a his blood oxygen saturation is
Dialogue: 0,0:38:26.06,0:38:28.11,Default,,0000,0000,0000,,normal on room air
Dialogue: 0,0:38:28.11,0:38:30.99,Default,,0000,0000,0000,,so these oxygen eighty five
Dialogue: 0,0:38:30.99,0:38:35.36,Default,,0000,0000,0000,,checkers respiratory rate at sixteen\Nthat's generally that's a little fast
Dialogue: 0,0:38:35.36,0:38:37.10,Default,,0000,0000,0000,,but it's probably okay but
Dialogue: 0,0:38:37.10,0:38:39.02,Default,,0000,0000,0000,,his pulse rate is a hundred and buy it\Nnow
Dialogue: 0,0:38:39.02,0:38:43.84,Default,,0000,0000,0000,,united now that a hundred five ezell\Nelevate we would call that eka kartik
Dialogue: 0,0:38:43.84,0:38:45.74,Default,,0000,0000,0000,,so he's technopark
Dialogue: 0,0:38:45.74,0:38:49.00,Default,,0000,0000,0000,,and you examine his loans as you will\Nlearn to do this year and you'll find
Dialogue: 0,0:38:49.00,0:38:52.95,Default,,0000,0000,0000,,when you became his patients' lungs that\Nhe has crackles
Dialogue: 0,0:38:52.95,0:38:54.54,Default,,0000,0000,0000,,n{\u1}t{\u0}s{\u1}b{\u0}'s
Dialogue: 0,0:38:54.54,0:38:56.34,Default,,0000,0000,0000,,user crackles are sort of
Dialogue: 0,0:38:56.34,0:38:57.05,Default,,0000,0000,0000,,they sound like crackers
Dialogue: 0,0:38:57.05,0:38:59.49,Default,,0000,0000,0000,,we've ever listen to rice crispy
Dialogue: 0,0:38:59.49,0:39:02.86,Default,,0000,0000,0000,,that's what it sounds like a bit sounds\Nwith inspiration you would get crap that
Dialogue: 0,0:39:02.86,0:39:06.43,Default,,0000,0000,0000,,usually indicates that there's some\Ndegree of a team up in the long some
Dialogue: 0,0:39:06.43,0:39:10.01,Default,,0000,0000,0000,,degree of swelling in the long and as\Nthe albee a liar trying to expand
Dialogue: 0,0:39:10.01,0:39:12.95,Default,,0000,0000,0000,,they pop open up a very easy way but\Nenough
Dialogue: 0,0:39:12.95,0:39:15.09,Default,,0000,0000,0000,,tough way because there's a lot of\Nsurface tension at each of you
Dialogue: 0,0:39:15.09,0:39:19.12,Default,,0000,0000,0000,,level because of the fluid in the\Ninterstitial space
Dialogue: 0,0:39:19.12,0:39:23.65,Default,,0000,0000,0000,,he's also got leases leases are\Nindications of airway obstruction small
Dialogue: 0,0:39:23.65,0:39:26.19,Default,,0000,0000,0000,,airways obstruction in the long
Dialogue: 0,0:39:26.19,0:39:29.10,Default,,0000,0000,0000,,but you'll also notice he doesn't have a\Nproblem which means that he doesn't have
Dialogue: 0,0:39:29.10,0:39:33.34,Default,,0000,0000,0000,,this sort of uh... inflammation in the\Npleural space which will learn about
Dialogue: 0,0:39:33.34,0:39:36.02,Default,,0000,0000,0000,,and he doesn't have evidence of\Nconsolidation consolidation would give
Dialogue: 0,0:39:36.02,0:39:39.04,Default,,0000,0000,0000,,you some clues that he might have an emo
Dialogue: 0,0:39:39.04,0:39:41.59,Default,,0000,0000,0000,,we don't have either of those
Dialogue: 0,0:39:41.59,0:39:44.45,Default,,0000,0000,0000,,but you also examine is like and you\Nfind that even though he didn't think it
Dialogue: 0,0:39:44.45,0:39:47.57,Default,,0000,0000,0000,,was a swollen it absolutely is well
Dialogue: 0,0:39:47.57,0:39:49.87,Default,,0000,0000,0000,,and you feel of any
Dialogue: 0,0:39:49.87,0:39:50.08,Default,,0000,0000,0000,,below his knee
Dialogue: 0,0:39:50.08,0:39:54.00,Default,,0000,0000,0000,,most of the time we should be able to\Nfeel the danes attorney but if they're
Dialogue: 0,0:39:54.00,0:39:56.01,Default,,0000,0000,0000,,inflamed possibly because of a clock
Dialogue: 0,0:39:56.01,0:39:58.44,Default,,0000,0000,0000,,you might feel below the knee
Dialogue: 0,0:39:58.44,0:40:01.93,Default,,0000,0000,0000,,you get a chest x-ray that's normal
Dialogue: 0,0:40:01.93,0:40:05.09,Default,,0000,0000,0000,,and you get the cagey in its shows that\Nhis heart's going fast but nothing's
Dialogue: 0,0:40:05.09,0:40:08.27,Default,,0000,0000,0000,,besides that
Dialogue: 0,0:40:08.27,0:40:10.87,Default,,0000,0000,0000,,so now what we do is we go back
Dialogue: 0,0:40:10.87,0:40:14.49,Default,,0000,0000,0000,,to the clinical prediction
Dialogue: 0,0:40:14.49,0:40:17.09,Default,,0000,0000,0000,,calculator and cd about entering in this\Ndata
Dialogue: 0,0:40:17.09,0:40:22.17,Default,,0000,0000,0000,,so the additional data that will get
Dialogue: 0,0:40:22.17,0:40:23.09,Default,,0000,0000,0000,,he not only is uh...
Dialogue: 0,0:40:23.09,0:40:27.02,Default,,0000,0000,0000,,sixty years old and mailing it to keep\Nthis thing out and let's say he's
Dialogue: 0,0:40:27.02,0:40:29.17,Default,,0000,0000,0000,,immobilized he was a mobile as
Dialogue: 0,0:40:29.17,0:40:34.100,Default,,0000,0000,0000,,we now find that he's gotten lateral\Nexcellent
Dialogue: 0,0:40:34.100,0:40:37.61,Default,,0000,0000,0000,,but that he also has leases
Dialogue: 0,0:40:37.61,0:40:40.61,Default,,0000,0000,0000,,contracts
Dialogue: 0,0:40:40.61,0:40:44.49,Default,,0000,0000,0000,,no notice what happens to pay attention\Nto the number as i enter the zip
Dialogue: 0,0:40:44.49,0:40:48.04,Default,,0000,0000,0000,,i started out with sixty percent by\Naditi lateral leg swelling what we're
Dialogue: 0,0:40:48.04,0:40:50.59,Default,,0000,0000,0000,,getting really close for x seventy five\Npercent
Dialogue: 0,0:40:50.59,0:40:52.72,Default,,0000,0000,0000,,but this person's that p
Dialogue: 0,0:40:52.72,0:40:53.10,Default,,0000,0000,0000,,upholding a bit
Dialogue: 0,0:40:53.10,0:40:57.06,Default,,0000,0000,0000,,remember we're talking about as long as\Neven though
Dialogue: 0,0:40:57.06,0:40:58.50,Default,,0000,0000,0000,,the race
Dialogue: 0,0:40:58.50,0:40:59.53,Default,,0000,0000,0000,,his lead
Dialogue: 0,0:40:59.53,0:41:02.01,Default,,0000,0000,0000,,because if you've got to cut your leg\Nyou're more likely to throw that but we
Dialogue: 0,0:41:02.01,0:41:05.03,Default,,0000,0000,0000,,have a pulmonary embolism those two are\Nnot
Dialogue: 0,0:41:05.03,0:41:06.62,Default,,0000,0000,0000,,independent features
Dialogue: 0,0:41:06.62,0:41:08.77,Default,,0000,0000,0000,,those who are dependent effects
Dialogue: 0,0:41:08.77,0:41:12.27,Default,,0000,0000,0000,,so it dries it up to seven six percent\Nbut knows what happened when i clicked
Dialogue: 0,0:41:12.27,0:41:14.47,Default,,0000,0000,0000,,on visas and practice
Dialogue: 0,0:41:14.47,0:41:18.27,Default,,0000,0000,0000,,that number within seventy five percent\Nof the thirty five percent
Dialogue: 0,0:41:18.27,0:41:19.92,Default,,0000,0000,0000,,so what in your mind
Dialogue: 0,0:41:19.92,0:41:21.84,Default,,0000,0000,0000,,must you be thinking
Dialogue: 0,0:41:21.84,0:41:24.10,Default,,0000,0000,0000,,the presents of crackles and we use is\Nactually make
Dialogue: 0,0:41:24.10,0:41:28.22,Default,,0000,0000,0000,,pulmonary embolism last like
Dialogue: 0,0:41:28.22,0:41:32.56,Default,,0000,0000,0000,,in fact pulmonary embolism the number\None clinical finding in the long for p
Dialogue: 0,0:41:32.56,0:41:33.73,Default,,0000,0000,0000,,is nothing
Dialogue: 0,0:41:33.73,0:41:36.41,Default,,0000,0000,0000,,subtotal e normal pulmonary exam
Dialogue: 0,0:41:36.41,0:41:38.89,Default,,0000,0000,0000,,just because you have a normal palm\Ntrees and doesn't mean you don't have a
Dialogue: 0,0:41:38.89,0:41:40.24,Default,,0000,0000,0000,,disease
Dialogue: 0,0:41:40.24,0:41:42.07,Default,,0000,0000,0000,,as an important consideration but keep\Nin mind that this is a way of
Dialogue: 0,0:41:42.07,0:41:43.06,Default,,0000,0000,0000,,quantifying
Dialogue: 0,0:41:43.06,0:41:44.71,Default,,0000,0000,0000,,how much
Dialogue: 0,0:41:44.71,0:41:49.01,Default,,0000,0000,0000,,dropped there is so we ever did all this\Ndata and we're now at around thirty five
Dialogue: 0,0:41:49.01,0:41:50.45,Default,,0000,0000,0000,,percent
Dialogue: 0,0:41:50.45,0:41:52.32,Default,,0000,0000,0000,,so turns out i was about
Dialogue: 0,0:41:52.32,0:42:06.17,Default,,0000,0000,0000,,or a percent was pretty close to thirty\Nfive pst
Dialogue: 0,0:42:06.17,0:42:10.05,Default,,0000,0000,0000,,there are interactional terms that are\Nbuilt into the mathematical model here
Dialogue: 0,0:42:10.05,0:42:13.58,Default,,0000,0000,0000,,so if you look above the rest
Dialogue: 0,0:42:13.58,0:42:18.16,Default,,0000,0000,0000,,and sold those interactions are built\Ninto how he calculates the factor some
Dialogue: 0,0:42:18.16,0:42:20.81,Default,,0000,0000,0000,,which then translates to what the risks
Dialogue: 0,0:42:20.81,0:42:23.09,Default,,0000,0000,0000,,so yes there are interaction terms\Nbetween these things
Dialogue: 0,0:42:23.09,0:42:26.63,Default,,0000,0000,0000,,and it's calc it's all done in the\Nbackground
Dialogue: 0,0:42:26.63,0:42:28.80,Default,,0000,0000,0000,,clinician you know i'm not gonna do that
Dialogue: 0,0:42:28.80,0:42:31.67,Default,,0000,0000,0000,,and i'm certainly not to be able to look\Nat a study be able to know how to do
Dialogue: 0,0:42:31.67,0:42:34.33,Default,,0000,0000,0000,,that that's why these calculators to be\Nvery helpful
Dialogue: 0,0:42:34.33,0:42:37.11,Default,,0000,0000,0000,,it'll give you an idea are we weigh off
Dialogue: 0,0:42:37.11,0:42:39.72,Default,,0000,0000,0000,,or are we about right is this guy is
Dialogue: 0,0:42:39.72,0:42:42.10,Default,,0000,0000,0000,,was my initial gut feeling over on\Ntarget yeah
Dialogue: 0,0:42:42.10,0:42:45.84,Default,,0000,0000,0000,,was kind of on target even when we did\Nmore data gathering
Dialogue: 0,0:42:45.84,0:42:47.02,Default,,0000,0000,0000,,but you also get a sense
Dialogue: 0,0:42:47.02,0:42:50.07,Default,,0000,0000,0000,,uh... why how different features\Nincrease and decrease the likelihood
Dialogue: 0,0:42:50.07,0:42:59.65,Default,,0000,0000,0000,,which is a good learning tool
Dialogue: 0,0:42:59.65,0:43:02.69,Default,,0000,0000,0000,,rate
Dialogue: 0,0:43:02.69,0:43:05.12,Default,,0000,0000,0000,,so the question is of why is
Dialogue: 0,0:43:05.12,0:43:06.92,Default,,0000,0000,0000,,smoking and wake nodding here
Dialogue: 0,0:43:06.92,0:43:10.53,Default,,0000,0000,0000,,the answer is is that smoking and wait\Nfor actually not considered risk factors
Dialogue: 0,0:43:10.53,0:43:12.68,Default,,0000,0000,0000,,for p
Dialogue: 0,0:43:12.68,0:43:15.77,Default,,0000,0000,0000,,when they've looked at these studies\Nwhat you might think of boy there smoker
Dialogue: 0,0:43:15.77,0:43:17.30,Default,,0000,0000,0000,,they're more likely to have a clock
Dialogue: 0,0:43:17.30,0:43:19.06,Default,,0000,0000,0000,,into israel
Dialogue: 0,0:43:19.06,0:43:21.27,Default,,0000,0000,0000,,just because you're a smoker doesn't\Nmean that you're more likely to have a
Dialogue: 0,0:43:21.27,0:43:22.31,Default,,0000,0000,0000,,p{\u1}e{\u0}
Dialogue: 0,0:43:22.31,0:43:25.04,Default,,0000,0000,0000,,now certain smokers do carry increase\Nfrom body chris
Dialogue: 0,0:43:25.04,0:43:28.07,Default,,0000,0000,0000,,if you're a young woman who smoking on\Nor contraceptives
Dialogue: 0,0:43:28.07,0:43:32.63,Default,,0000,0000,0000,,you already higher risk of developing a\Nlower extremity d{\u1}d{\u0}t_
Dialogue: 0,0:43:32.63,0:43:33.82,Default,,0000,0000,0000,,at is clear
Dialogue: 0,0:43:33.82,0:43:36.83,Default,,0000,0000,0000,,but that's not necessarily what we're\Ntalking about here
Dialogue: 0,0:43:36.83,0:43:39.88,Default,,0000,0000,0000,,over the lot big picture it doesn't\Ncontribute risk
Dialogue: 0,0:43:39.88,0:43:42.71,Default,,0000,0000,0000,,it also could be because the studies\Nwere done but in this case is because
Dialogue: 0,0:43:42.71,0:43:51.66,Default,,0000,0000,0000,,they're not respect
Dialogue: 0,0:43:51.66,0:43:52.51,Default,,0000,0000,0000,,uh...
Dialogue: 0,0:43:52.51,0:43:55.84,Default,,0000,0000,0000,,so here's the question if you are\Nthinking that there is a nother
Dialogue: 0,0:43:55.84,0:43:59.60,Default,,0000,0000,0000,,possibility on your differential\Ndiagnosis that is either equally or more
Dialogue: 0,0:43:59.60,0:44:04.02,Default,,0000,0000,0000,,likely does it drive this down the\Nabsentee answers absolutely it does
Dialogue: 0,0:44:04.02,0:44:06.04,Default,,0000,0000,0000,,and there are limits to these clinical\Nprediction
Dialogue: 0,0:44:06.04,0:44:09.05,Default,,0000,0000,0000,,so this is done in a vacuum their other\Nclinical prediction rules
Dialogue: 0,0:44:09.05,0:44:13.03,Default,,0000,0000,0000,,where you can actually have a button\Nthat says is an alternative diagnosis
Dialogue: 0,0:44:13.03,0:44:17.55,Default,,0000,0000,0000,,equally or more likely when you do that\Npeople drop your s
Dialogue: 0,0:44:17.55,0:44:20.04,Default,,0000,0000,0000,,because it knows that there may be other\Nthings going up this prediction will
Dialogue: 0,0:44:20.04,0:44:25.03,Default,,0000,0000,0000,,didn't do that
Dialogue: 0,0:44:25.03,0:44:29.04,Default,,0000,0000,0000,,station had a family history of a d{\u1}d{\u0}t_\Nbut not a personal history dvd if you're
Dialogue: 0,0:44:29.04,0:44:33.01,Default,,0000,0000,0000,,interested in what that would have done\Nyou could do it if he had a dvd in the
Dialogue: 0,0:44:33.01,0:44:34.27,Default,,0000,0000,0000,,past
Dialogue: 0,0:44:34.27,0:44:38.54,Default,,0000,0000,0000,,it drives up from thirty five to fifty
Dialogue: 0,0:44:38.54,0:44:41.98,Default,,0000,0000,0000,,yet family history of some of his family\Nwith d
Dialogue: 0,0:44:41.98,0:44:45.29,Default,,0000,0000,0000,,all these are great questions but the\Nmost important thing to keep in mind is
Dialogue: 0,0:44:45.29,0:44:48.30,Default,,0000,0000,0000,,you don't just have to go on gut feel
Dialogue: 0,0:44:48.30,0:44:51.29,Default,,0000,0000,0000,,at these clinical prediction rules for\Ncommon diseases which are the ones that
Dialogue: 0,0:44:51.29,0:44:51.10,Default,,0000,0000,0000,,are out there
Dialogue: 0,0:44:51.10,0:44:53.07,Default,,0000,0000,0000,,can help you understand
Dialogue: 0,0:44:53.07,0:44:58.25,Default,,0000,0000,0000,,the clinical manifestations of a\Nparticular disease
Dialogue: 0,0:44:58.25,0:45:00.86,Default,,0000,0000,0000,,so what does this have to do with what\Nwe do
Dialogue: 0,0:45:00.86,0:45:05.13,Default,,0000,0000,0000,,well keep in mind we're now
Dialogue: 0,0:45:05.13,0:45:06.59,Default,,0000,0000,0000,,we are now at
Dialogue: 0,0:45:06.59,0:45:09.09,Default,,0000,0000,0000,,um having completed our data gathering\Nthings were based
Dialogue: 0,0:45:09.09,0:45:12.06,Default,,0000,0000,0000,,with the prior probability of about\Nthirty five percent
Dialogue: 0,0:45:12.06,0:45:14.95,Default,,0000,0000,0000,,at the station is happy
Dialogue: 0,0:45:14.95,0:45:16.01,Default,,0000,0000,0000,,and so what we need to do you think\Nabout
Dialogue: 0,0:45:16.01,0:45:18.82,Default,,0000,0000,0000,,do we need to get a test
Dialogue: 0,0:45:18.82,0:45:21.29,Default,,0000,0000,0000,,because the question that should be\Ngoing through your mind is the thirty
Dialogue: 0,0:45:21.29,0:45:25.38,Default,,0000,0000,0000,,five percent high enough at allstate\Nyahoo dot abt and got a pulmonary
Dialogue: 0,0:45:25.38,0:45:26.02,Default,,0000,0000,0000,,embolism
Dialogue: 0,0:45:26.02,0:45:28.09,Default,,0000,0000,0000,,we're gonna treat you as such
Dialogue: 0,0:45:28.09,0:45:31.15,Default,,0000,0000,0000,,hopefully thirty five percent is too low\Nfor even you
Dialogue: 0,0:45:31.15,0:45:34.53,Default,,0000,0000,0000,,to say boy i don't think that i would\Npoint to treat based on that certainly
Dialogue: 0,0:45:34.53,0:45:39.50,Default,,0000,0000,0000,,would be low for most of the nation's we\Nneed to probably get some sort of text
Dialogue: 0,0:45:39.50,0:45:44.49,Default,,0000,0000,0000,,so what this is a how those bridges over\Ninto diagnostic test
Dialogue: 0,0:45:44.49,0:45:47.49,Default,,0000,0000,0000,,so here is the question what we do with\Nthis number
Dialogue: 0,0:45:47.49,0:45:51.25,Default,,0000,0000,0000,,well if there was a test that existed\Nthat could rule in pulmonary embolism as
Dialogue: 0,0:45:51.25,0:45:52.02,Default,,0000,0000,0000,,the diagnosis
Dialogue: 0,0:45:52.02,0:45:54.01,Default,,0000,0000,0000,,with a hundred percent sense certainty
Dialogue: 0,0:45:54.01,0:46:00.53,Default,,0000,0000,0000,,we would be saying that probability of\Nthis of a patient having a p
Dialogue: 0,0:46:00.53,0:46:01.02,Default,,0000,0000,0000,,due to the
Dialogue: 0,0:46:01.02,0:46:02.07,Default,,0000,0000,0000,,at the test is positive
Dialogue: 0,0:46:02.07,0:46:05.62,Default,,0000,0000,0000,,is a hundred percent
Dialogue: 0,0:46:05.62,0:46:09.27,Default,,0000,0000,0000,,and the question i would ask you is what\Nis the stressful
Dialogue: 0,0:46:09.27,0:46:13.24,Default,,0000,0000,0000,,what we call this test the boot stain
Dialogue: 0,0:46:13.24,0:46:18.29,Default,,0000,0000,0000,,the gold standard generally exist for\Nmore most conditions where they're is
Dialogue: 0,0:46:18.29,0:46:22.10,Default,,0000,0000,0000,,where works for the past week after the\Nfinding of the best will stand at the
Dialogue: 0,0:46:22.10,0:46:23.25,Default,,0000,0000,0000,,top
Dialogue: 0,0:46:23.25,0:46:25.01,Default,,0000,0000,0000,,uh... it may not be the best test
Dialogue: 0,0:46:25.01,0:46:26.04,Default,,0000,0000,0000,,that we can envision
Dialogue: 0,0:46:26.04,0:46:27.07,Default,,0000,0000,0000,,but it's the best test
Dialogue: 0,0:46:27.07,0:46:32.23,Default,,0000,0000,0000,,that is available
Dialogue: 0,0:46:32.23,0:46:35.50,Default,,0000,0000,0000,,and the question that i would ask is if\Nyou use the gold standard tests and you
Dialogue: 0,0:46:35.50,0:46:37.86,Default,,0000,0000,0000,,found it
Dialogue: 0,0:46:37.86,0:46:39.00,Default,,0000,0000,0000,,the test was positive
Dialogue: 0,0:46:39.00,0:46:42.10,Default,,0000,0000,0000,,is the probability of an alternative\Ndiagnosis remember that a test test
Dialogue: 0,0:46:42.10,0:46:46.34,Default,,0000,0000,0000,,that's a gold standard is only the gold\Nstandard or particular diagnosis
Dialogue: 0,0:46:46.34,0:46:48.51,Default,,0000,0000,0000,,let's say there's another diagnosis
Dialogue: 0,0:46:48.51,0:46:49.72,Default,,0000,0000,0000,,that you're interested in
Dialogue: 0,0:46:49.72,0:46:50.87,Default,,0000,0000,0000,,is it zero
Dialogue: 0,0:46:50.87,0:46:52.03,Default,,0000,0000,0000,,if the test is positive
Dialogue: 0,0:46:52.03,0:46:53.04,Default,,0000,0000,0000,,the answer is no
Dialogue: 0,0:46:53.04,0:46:54.28,Default,,0000,0000,0000,,because
Dialogue: 0,0:46:54.28,0:46:56.04,Default,,0000,0000,0000,,sometimes you have two things going on
Dialogue: 0,0:46:56.04,0:46:58.25,Default,,0000,0000,0000,,sometimes there are vents
Dialogue: 0,0:46:58.25,0:47:00.100,Default,,0000,0000,0000,,that are related to each other dependent\Non each other
Dialogue: 0,0:47:00.100,0:47:02.07,Default,,0000,0000,0000,,for sometimes you just have bad luck
Dialogue: 0,0:47:02.07,0:47:03.64,Default,,0000,0000,0000,,as a patient
Dialogue: 0,0:47:03.64,0:47:06.62,Default,,0000,0000,0000,,and you have both pulmonary embolism and\Nc{\u1}h{\u0}a_
Dialogue: 0,0:47:06.62,0:47:08.09,Default,,0000,0000,0000,,but the most important to keep thing to\Nkeep in mind
Dialogue: 0,0:47:08.09,0:47:12.28,Default,,0000,0000,0000,,is that we are always looking to see\Nwhat the gold standard is
Dialogue: 0,0:47:12.28,0:47:16.46,Default,,0000,0000,0000,,but we can't always used to go see
Dialogue: 0,0:47:16.46,0:47:19.79,Default,,0000,0000,0000,,so what is that not stick testing people\Nbut not the testing
Dialogue: 0,0:47:19.79,0:47:23.04,Default,,0000,0000,0000,,the the goal of diagnostic testing is to\Nhelp us modify probabilities
Dialogue: 0,0:47:23.04,0:47:24.01,Default,,0000,0000,0000,,we talked about how
Dialogue: 0,0:47:24.01,0:47:29.02,Default,,0000,0000,0000,,we modify probabilities based on history\Ntaking physical exam other simple tests
Dialogue: 0,0:47:29.02,0:47:32.02,Default,,0000,0000,0000,,complex s like the ones we're gonna talk\Nabout
Dialogue: 0,0:47:32.02,0:47:34.63,Default,,0000,0000,0000,,will help modify probabilities as well
Dialogue: 0,0:47:34.63,0:47:36.13,Default,,0000,0000,0000,,but they cost a lot of money
Dialogue: 0,0:47:36.13,0:47:39.02,Default,,0000,0000,0000,,and so we need to approach argues a\Ndiagnostic tests
Dialogue: 0,0:47:39.02,0:47:42.27,Default,,0000,0000,0000,,judicious
Dialogue: 0,0:47:42.27,0:47:45.07,Default,,0000,0000,0000,,so in order to understand what we're\Nlooking for work in a study about
Dialogue: 0,0:47:45.07,0:47:48.12,Default,,0000,0000,0000,,diagnostic test we need to understand
Dialogue: 0,0:47:48.12,0:47:53.100,Default,,0000,0000,0000,,how people related items to test
Dialogue: 0,0:47:53.100,0:47:56.05,Default,,0000,0000,0000,,really does relate instead of
Dialogue: 0,0:47:56.05,0:47:57.55,Default,,0000,0000,0000,,the patient
Dialogue: 0,0:47:57.55,0:47:59.09,Default,,0000,0000,0000,,uh... population were interested in
Dialogue: 0,0:47:59.09,0:48:02.05,Default,,0000,0000,0000,,what we're really trying to use the\Nfollowing
Dialogue: 0,0:48:02.05,0:48:05.17,Default,,0000,0000,0000,,a disease state
Dialogue: 0,0:48:05.17,0:48:07.80,Default,,0000,0000,0000,,what is the disease that we're trying to\Ndiagnose
Dialogue: 0,0:48:07.80,0:48:11.11,Default,,0000,0000,0000,,in this particular case if ur interested\Nin another test to use
Dialogue: 0,0:48:11.11,0:48:14.39,Default,,0000,0000,0000,,it would be the disease state would be a\Npulmonary embolism
Dialogue: 0,0:48:14.39,0:48:15.58,Default,,0000,0000,0000,,intervention
Dialogue: 0,0:48:15.58,0:48:19.81,Default,,0000,0000,0000,,would actually be the test itself so\Nwhat tester we interested in his room
Dialogue: 0,0:48:19.81,0:48:22.28,Default,,0000,0000,0000,,looking through the literature
Dialogue: 0,0:48:22.28,0:48:25.100,Default,,0000,0000,0000,,the comparison group is not another\Ntherapy but it was in the therapeutic
Dialogue: 0,0:48:25.100,0:48:26.08,Default,,0000,0000,0000,,questions
Dialogue: 0,0:48:26.08,0:48:28.75,Default,,0000,0000,0000,,it's the gold standard
Dialogue: 0,0:48:28.75,0:48:30.05,Default,,0000,0000,0000,,so you're trying to compare
Dialogue: 0,0:48:30.05,0:48:32.10,Default,,0000,0000,0000,,a test of interest
Dialogue: 0,0:48:32.10,0:48:34.84,Default,,0000,0000,0000,,against what is the best test that's out\Nthere
Dialogue: 0,0:48:34.84,0:48:37.46,Default,,0000,0000,0000,,the problem with the best test that's\Nout there is that it's frequently
Dialogue: 0,0:48:37.46,0:48:38.03,Default,,0000,0000,0000,,infeasible
Dialogue: 0,0:48:38.03,0:48:41.03,Default,,0000,0000,0000,,sometimes dangerous even though it's the\Nbest s so we're looking for an
Dialogue: 0,0:48:41.03,0:48:44.05,Default,,0000,0000,0000,,alternative test that we can use i can\Nhelp us with our page so that those
Dialogue: 0,0:48:44.05,0:48:46.28,Default,,0000,0000,0000,,favoritism
Dialogue: 0,0:48:46.28,0:48:49.88,Default,,0000,0000,0000,,and then the outcome of interest that\Nwere interested in is the performance of
Dialogue: 0,0:48:49.88,0:48:51.15,Default,,0000,0000,0000,,the text
Dialogue: 0,0:48:51.15,0:48:53.88,Default,,0000,0000,0000,,that's the fundamental
Dialogue: 0,0:48:53.88,0:48:55.36,Default,,0000,0000,0000,,and you will be able to
Dialogue: 0,0:48:55.36,0:48:56.02,Default,,0000,0000,0000,,do this
Dialogue: 0,0:48:56.02,0:48:59.04,Default,,0000,0000,0000,,over and over again as you're looking at\Ndifferent studies and we've this is part
Dialogue: 0,0:48:59.04,0:49:00.29,Default,,0000,0000,0000,,of the assignment
Dialogue: 0,0:49:00.29,0:49:02.14,Default,,0000,0000,0000,,for two more
Dialogue: 0,0:49:02.14,0:49:04.46,Default,,0000,0000,0000,,so let's practice
Dialogue: 0,0:49:04.46,0:49:07.69,Default,,0000,0000,0000,,as we've seen the sixty location without\Nheart disease is presenting with some
Dialogue: 0,0:49:07.69,0:49:09.20,Default,,0000,0000,0000,,nonsense shortness of breath
Dialogue: 0,0:49:09.20,0:49:11.23,Default,,0000,0000,0000,,we're considering a p
Dialogue: 0,0:49:11.23,0:49:14.49,Default,,0000,0000,0000,,that would be our disease or our p
Dialogue: 0,0:49:14.49,0:49:19.27,Default,,0000,0000,0000,,protest and ask us to consider is a test\Ncollabera profusion scheme
Dialogue: 0,0:49:19.27,0:49:21.02,Default,,0000,0000,0000,,cowbell asian perfusion scan
Dialogue: 0,0:49:21.02,0:49:23.94,Default,,0000,0000,0000,,is something that's been around for a\Nlong time
Dialogue: 0,0:49:23.94,0:49:25.59,Default,,0000,0000,0000,,it basically
Dialogue: 0,0:49:25.59,0:49:28.03,Default,,0000,0000,0000,,in the test a patient in hale's
Dialogue: 0,0:49:28.03,0:49:31.90,Default,,0000,0000,0000,,or radio nuclei partner
Dialogue: 0,0:49:31.90,0:49:36.63,Default,,0000,0000,0000,,and we see where that radio nuclei\Nparticle goals
Dialogue: 0,0:49:36.63,0:49:40.24,Default,,0000,0000,0000,,and in addition the patient gets\Ninjected with that same radio nuclear
Dialogue: 0,0:49:40.24,0:49:41.14,Default,,0000,0000,0000,,particle
Dialogue: 0,0:49:41.14,0:49:43.96,Default,,0000,0000,0000,,and we see based on the blood flow
Dialogue: 0,0:49:43.96,0:49:45.25,Default,,0000,0000,0000,,that particle goes
Dialogue: 0,0:49:45.25,0:49:46.77,Default,,0000,0000,0000,,we take pictures
Dialogue: 0,0:49:46.77,0:49:49.85,Default,,0000,0000,0000,,simplistic explanation but i thought you\Nreally need to know at this point
Dialogue: 0,0:49:49.85,0:49:51.85,Default,,0000,0000,0000,,and what we're looking for is
Dialogue: 0,0:49:51.85,0:49:54.03,Default,,0000,0000,0000,,where does the air go
Dialogue: 0,0:49:54.03,0:49:56.55,Default,,0000,0000,0000,,that blood doesn't go
Dialogue: 0,0:49:56.55,0:49:59.49,Default,,0000,0000,0000,,but that there's a place where the air\Ngoes that the blood doesn't go that
Dialogue: 0,0:49:59.49,0:50:02.67,Default,,0000,0000,0000,,would likely be where o'clock would be
Dialogue: 0,0:50:02.67,0:50:04.40,Default,,0000,0000,0000,,api
Dialogue: 0,0:50:04.40,0:50:07.60,Default,,0000,0000,0000,,but that's what happens is that the\Nclock obstructs blood flow to that
Dialogue: 0,0:50:07.60,0:50:10.22,Default,,0000,0000,0000,,particular place
Dialogue: 0,0:50:10.22,0:50:12.55,Default,,0000,0000,0000,,now the gold standard
Dialogue: 0,0:50:12.55,0:50:16.49,Default,,0000,0000,0000,,four diagnosis of a pulmonary embolism\Nsomething we call pulmonary and
Dialogue: 0,0:50:16.49,0:50:17.38,Default,,0000,0000,0000,,geography
Dialogue: 0,0:50:17.38,0:50:20.74,Default,,0000,0000,0000,,which is where you were actually\Ninjecting died and watching where the
Dialogue: 0,0:50:20.74,0:50:22.09,Default,,0000,0000,0000,,blood blow goes
Dialogue: 0,0:50:22.09,0:50:24.07,Default,,0000,0000,0000,,you see a picture of a b q scan on the\Ntop there
Dialogue: 0,0:50:24.07,0:50:28.94,Default,,0000,0000,0000,,on the bottom is a very grainy picture\Nof a pulmonary angiogram
Dialogue: 0,0:50:28.94,0:50:31.41,Default,,0000,0000,0000,,just keep in mind that an angiogram
Dialogue: 0,0:50:31.41,0:50:33.51,Default,,0000,0000,0000,,more costly
Dialogue: 0,0:50:33.51,0:50:37.38,Default,,0000,0000,0000,,slightly more dangerous
Dialogue: 0,0:50:37.38,0:50:38.95,Default,,0000,0000,0000,,the gold standard
Dialogue: 0,0:50:38.95,0:50:42.54,Default,,0000,0000,0000,,but we wouldn't because it's costly and\Nmore dangerous we wouldn't offered to
Dialogue: 0,0:50:42.54,0:50:43.82,Default,,0000,0000,0000,,all patients
Dialogue: 0,0:50:43.82,0:50:44.82,Default,,0000,0000,0000,,because if we did that
Dialogue: 0,0:50:44.82,0:50:48.03,Default,,0000,0000,0000,,the risk that we would in anyone who we\Nsuspect has a p
Dialogue: 0,0:50:48.03,0:50:51.01,Default,,0000,0000,0000,,the amount of complications and cost\Nthat we would entail
Dialogue: 0,0:50:51.01,0:50:53.01,Default,,0000,0000,0000,,would be mass
Dialogue: 0,0:50:53.01,0:50:56.01,Default,,0000,0000,0000,,that's what we're looking to see is is\Nof the few scan which is actually
Dialogue: 0,0:50:56.01,0:50:58.61,Default,,0000,0000,0000,,fairly
Dialogue: 0,0:50:58.61,0:51:00.54,Default,,0000,0000,0000,,really fairly
Dialogue: 0,0:51:00.54,0:51:02.35,Default,,0000,0000,0000,,at not terribly dangerous
Dialogue: 0,0:51:02.35,0:51:05.04,Default,,0000,0000,0000,,whether that would be good enough\Ncompared to the gold standard for many
Dialogue: 0,0:51:05.04,0:51:07.01,Default,,0000,0000,0000,,of the geography
Dialogue: 0,0:51:07.01,0:51:10.23,Default,,0000,0000,0000,,what were interested in is diagnostic\Nperformance
Dialogue: 0,0:51:10.23,0:51:16.71,Default,,0000,0000,0000,,so that is the pico recognize the test
Dialogue: 0,0:51:16.71,0:51:20.50,Default,,0000,0000,0000,,but before thinking about it became\Nscandal then elation perfusion scamper
Dialogue: 0,0:51:20.50,0:51:23.10,Default,,0000,0000,0000,,first question we have to ask
Dialogue: 0,0:51:23.10,0:51:26.30,Default,,0000,0000,0000,,kena beat you scan actually even be used
Dialogue: 0,0:51:26.30,0:51:28.78,Default,,0000,0000,0000,,now you will be asking this question as\Na clinician
Dialogue: 0,0:51:28.78,0:51:31.04,Default,,0000,0000,0000,,but before you can even go to market
Dialogue: 0,0:51:31.04,0:51:32.03,Default,,0000,0000,0000,,as a possible test
Dialogue: 0,0:51:32.03,0:51:35.04,Default,,0000,0000,0000,,there's some fundamental questions about\Na diagnostic test
Dialogue: 0,0:51:35.04,0:51:38.60,Default,,0000,0000,0000,,that require some definitions that you\Nshould be aware
Dialogue: 0,0:51:38.60,0:51:42.30,Default,,0000,0000,0000,,and they thought this on to concerts\Naccuracy and precision in order for a
Dialogue: 0,0:51:42.30,0:51:43.08,Default,,0000,0000,0000,,test to be used
Dialogue: 0,0:51:43.08,0:51:47.58,Default,,0000,0000,0000,,in the literature and study for possible\Nuse it needs to be accurate
Dialogue: 0,0:51:47.58,0:51:50.40,Default,,0000,0000,0000,,and it needs to be precise or whining\Nabout it
Dialogue: 0,0:51:50.40,0:51:53.05,Default,,0000,0000,0000,,what accuracy means at the results of\Nthe test
Dialogue: 0,0:51:53.05,0:51:57.21,Default,,0000,0000,0000,,corresponds consistently with from\Nresult
Dialogue: 0,0:51:57.21,0:52:00.84,Default,,0000,0000,0000,,not going to result in terms of\Ndiagnosing the disease
Dialogue: 0,0:52:00.84,0:52:02.52,Default,,0000,0000,0000,,but the correct about
Dialogue: 0,0:52:02.52,0:52:05.62,Default,,0000,0000,0000,,meaning that it'd be q skin if i object
Dialogue: 0,0:52:05.62,0:52:08.71,Default,,0000,0000,0000,,the radio nuclei and i say it goes to\Nthe long
Dialogue: 0,0:52:08.71,0:52:10.96,Default,,0000,0000,0000,,if you go to the law
Dialogue: 0,0:52:10.96,0:52:15.03,Default,,0000,0000,0000,,and if i inhale the radio nuclei and i\Nsay he should be inhaled into the
Dialogue: 0,0:52:15.03,0:52:16.57,Default,,0000,0000,0000,,alveolar space
Dialogue: 0,0:52:16.57,0:52:21.04,Default,,0000,0000,0000,,it should actually be inhaled into the\Nalveolar sticks
Dialogue: 0,0:52:21.04,0:52:21.73,Default,,0000,0000,0000,,fundamental
Dialogue: 0,0:52:21.73,0:52:25.22,Default,,0000,0000,0000,,but keep in mind that there is a clone\Nof work that happens
Dialogue: 0,0:52:25.22,0:52:28.62,Default,,0000,0000,0000,,prior to attest going to study
Dialogue: 0,0:52:28.62,0:52:31.23,Default,,0000,0000,0000,,that requires this to happen
Dialogue: 0,0:52:31.23,0:52:33.84,Default,,0000,0000,0000,,and there's a lot of science behind us
Dialogue: 0,0:52:33.84,0:52:35.07,Default,,0000,0000,0000,,so needs to be accurate enemies
Dialogue: 0,0:52:35.07,0:52:39.06,Default,,0000,0000,0000,,besides we're learning about the size\Ntwelve decision means that if you do
Dialogue: 0,0:52:39.06,0:52:43.31,Default,,0000,0000,0000,,with over and over again on the same\Npatient you'll get the same result
Dialogue: 0,0:52:43.31,0:52:45.48,Default,,0000,0000,0000,,with a reliable test
Dialogue: 0,0:52:45.48,0:52:50.23,Default,,0000,0000,0000,,the repeated values on the same sample\Nresume results in the same down
Dialogue: 0,0:52:50.23,0:52:53.53,Default,,0000,0000,0000,,so in the same patient you do it once\Nyou do it again five minutes later you
Dialogue: 0,0:52:53.53,0:52:54.07,Default,,0000,0000,0000,,you five minutes later
Dialogue: 0,0:52:54.07,0:52:56.74,Default,,0000,0000,0000,,missing uh... results actually happened
Dialogue: 0,0:52:56.74,0:52:58.93,Default,,0000,0000,0000,,that's the preciseness
Dialogue: 0,0:52:58.93,0:53:00.49,Default,,0000,0000,0000,,you need to have both
Dialogue: 0,0:53:00.49,0:53:02.74,Default,,0000,0000,0000,,they're actually three different
Dialogue: 0,0:53:02.74,0:53:04.61,Default,,0000,0000,0000,,possibilities that tend to happen
Dialogue: 0,0:53:04.61,0:53:05.91,Default,,0000,0000,0000,,when early
Dialogue: 0,0:53:05.91,0:53:09.11,Default,,0000,0000,0000,,phase studies are done and diagnostic\Ntests
Dialogue: 0,0:53:09.11,0:53:10.05,Default,,0000,0000,0000,,the first is the one that you want
Dialogue: 0,0:53:10.05,0:53:13.04,Default,,0000,0000,0000,,want to be highly accurate and highly\Nprecise pointed out that you're good to
Dialogue: 0,0:53:13.04,0:53:13.09,Default,,0000,0000,0000,,go
Dialogue: 0,0:53:13.09,0:53:16.84,Default,,0000,0000,0000,,ready to go to step two and study its\Ncharacteristics
Dialogue: 0,0:53:16.84,0:53:17.99,Default,,0000,0000,0000,,however
Dialogue: 0,0:53:17.99,0:53:20.36,Default,,0000,0000,0000,,you can have something very precise
Dialogue: 0,0:53:20.36,0:53:22.70,Default,,0000,0000,0000,,but be completely inaccurate
Dialogue: 0,0:53:22.70,0:53:25.71,Default,,0000,0000,0000,,that's what's represented conceptually\Nby the bulls on where you have a lot of
Dialogue: 0,0:53:25.71,0:53:28.02,Default,,0000,0000,0000,,different numbers there clustering all\Naround the same area
Dialogue: 0,0:53:28.02,0:53:31.99,Default,,0000,0000,0000,,but it's actually not doing what you\Nthink it's doing
Dialogue: 0,0:53:31.99,0:53:34.15,Default,,0000,0000,0000,,and then there is sometimes when you\Nhave
Dialogue: 0,0:53:34.15,0:53:37.59,Default,,0000,0000,0000,,reasonable accuracy it's all clustered\Naround the bulls eye
Dialogue: 0,0:53:37.59,0:53:38.93,Default,,0000,0000,0000,,but low precision
Dialogue: 0,0:53:38.93,0:53:40.53,Default,,0000,0000,0000,,their hat you get different
Dialogue: 0,0:53:40.53,0:53:42.84,Default,,0000,0000,0000,,answers each time you do it
Dialogue: 0,0:53:42.84,0:53:45.04,Default,,0000,0000,0000,,so what do you do in these different\Nsituations
Dialogue: 0,0:53:45.04,0:53:48.46,Default,,0000,0000,0000,,well the first into a single one step to\Nyour butt
Dialogue: 0,0:53:48.46,0:53:51.25,Default,,0000,0000,0000,,the second one you gotta think about\Ncalibration
Dialogue: 0,0:53:51.25,0:53:56.61,Default,,0000,0000,0000,,and you need to reset or maybe you need\Nto relook at the reagents veteran vault
Dialogue: 0,0:53:56.61,0:53:59.18,Default,,0000,0000,0000,,at a particular test itself
Dialogue: 0,0:53:59.18,0:54:02.63,Default,,0000,0000,0000,,in the last one unfortunately you gotta\Nstart over
Dialogue: 0,0:54:02.63,0:54:06.28,Default,,0000,0000,0000,,if you've got a bunch of if you're a\Ntest is not precise how usable could
Dialogue: 0,0:54:06.28,0:54:07.56,Default,,0000,0000,0000,,actually be
Dialogue: 0,0:54:07.56,0:54:10.03,Default,,0000,0000,0000,,you have to actually get the precision\Ndeath
Dialogue: 0,0:54:10.03,0:54:12.07,Default,,0000,0000,0000,,again this may seem fundamental in\Nfoundational
Dialogue: 0,0:54:12.07,0:54:16.49,Default,,0000,0000,0000,,but there are so many things that don't\Nmake it to market for even testing
Dialogue: 0,0:54:16.49,0:54:18.45,Default,,0000,0000,0000,,because they don't meet these criteria
Dialogue: 0,0:54:18.45,0:54:21.53,Default,,0000,0000,0000,,important for you to keep him
Dialogue: 0,0:54:21.53,0:54:25.75,Default,,0000,0000,0000,,once you make it past that first phase\Nthen you can decide
Dialogue: 0,0:54:25.75,0:54:30.44,Default,,0000,0000,0000,,diagnostic performance it what the\Ndiagnostic performances the o of the
Dialogue: 0,0:54:30.44,0:54:32.97,Default,,0000,0000,0000,,pico for diagnostic tests
Dialogue: 0,0:54:32.97,0:54:34.02,Default,,0000,0000,0000,,and so fundamentally
Dialogue: 0,0:54:34.02,0:54:37.08,Default,,0000,0000,0000,,i would ask you to think about two\Nthings
Dialogue: 0,0:54:37.08,0:54:41.06,Default,,0000,0000,0000,,any good diagnostic study does this
Dialogue: 0,0:54:41.06,0:54:43.77,Default,,0000,0000,0000,,they take a well-defined group of people
Dialogue: 0,0:54:43.77,0:54:46.68,Default,,0000,0000,0000,,who are at risk for a particular\Ncondition
Dialogue: 0,0:54:46.68,0:54:49.10,Default,,0000,0000,0000,,a whole population of them and they\Nexpose them to
Dialogue: 0,0:54:49.10,0:54:52.16,Default,,0000,0000,0000,,the experimental tests
Dialogue: 0,0:54:52.16,0:54:54.97,Default,,0000,0000,0000,,and the gold st
Dialogue: 0,0:54:54.97,0:54:57.70,Default,,0000,0000,0000,,everyone in the study needs to have both
Dialogue: 0,0:54:57.70,0:55:01.14,Default,,0000,0000,0000,,and if you compare the test results
Dialogue: 0,0:55:01.14,0:55:02.38,Default,,0000,0000,0000,,experimental tests
Dialogue: 0,0:55:02.38,0:55:04.68,Default,,0000,0000,0000,,and the gold standard
Dialogue: 0,0:55:04.68,0:55:07.88,Default,,0000,0000,0000,,keep in mind you don't want that patient\Npopulation to be
Dialogue: 0,0:55:07.88,0:55:11.09,Default,,0000,0000,0000,,everyone having the disease a hunter\Npercent of them having the disease
Dialogue: 0,0:55:11.09,0:55:12.05,Default,,0000,0000,0000,,you need to have a fair number
Dialogue: 0,0:55:12.05,0:55:15.00,Default,,0000,0000,0000,,of people who don't have the disease in\Norder to test
Dialogue: 0,0:55:15.00,0:55:16.96,Default,,0000,0000,0000,,the test characteristics
Dialogue: 0,0:55:16.96,0:55:20.08,Default,,0000,0000,0000,,well that's the fundamental premise of\Nany good diagnostic study and you'll be
Dialogue: 0,0:55:20.08,0:55:22.63,Default,,0000,0000,0000,,able to recognize he's
Dialogue: 0,0:55:22.63,0:55:26.44,Default,,0000,0000,0000,,what we can do is determine the strength\Nof the association
Dialogue: 0,0:55:26.44,0:55:30.46,Default,,0000,0000,0000,,between the study results of the\Ndiagnostic test
Dialogue: 0,0:55:30.46,0:55:34.12,Default,,0000,0000,0000,,of interest and the gold standard\Nmissiles he just comparing the two how
Dialogue: 0,0:55:34.12,0:55:36.29,Default,,0000,0000,0000,,well do they compare against each other
Dialogue: 0,0:55:36.29,0:55:39.68,Default,,0000,0000,0000,,the strength of all of that statistical\Nsignificance is the degree of
Dialogue: 0,0:55:39.68,0:55:44.66,Default,,0000,0000,0000,,correlation begin the accuracy or not\Nyet received the test results all the
Dialogue: 0,0:55:44.66,0:55:49.33,Default,,0000,0000,0000,,two different tests that are on in this\Nparticular set
Dialogue: 0,0:55:49.33,0:55:52.83,Default,,0000,0000,0000,,clinical significance is another factor\Nwe're not going to talk about that
Dialogue: 0,0:55:52.83,0:55:54.21,Default,,0000,0000,0000,,right now
Dialogue: 0,0:55:54.21,0:55:58.72,Default,,0000,0000,0000,,well what we need to do is focus on\Nstatistical significance
Dialogue: 0,0:55:58.72,0:56:01.64,Default,,0000,0000,0000,,so before we break i'm just going to
Dialogue: 0,0:56:01.64,0:56:04.69,Default,,0000,0000,0000,,present to you with the way that i'm\Ngonna ask you
Dialogue: 0,0:56:04.69,0:56:05.80,Default,,0000,0000,0000,,to think about
Dialogue: 0,0:56:05.80,0:56:07.09,Default,,0000,0000,0000,,and represent that data
Dialogue: 0,0:56:07.09,0:56:11.05,Default,,0000,0000,0000,,from a diagnostic study that does\Nexactly what
Dialogue: 0,0:56:11.05,0:56:13.98,Default,,0000,0000,0000,,what i'd just out
Dialogue: 0,0:56:13.98,0:56:17.08,Default,,0000,0000,0000,,a diagnostic study you are looking at
Dialogue: 0,0:56:17.08,0:56:18.35,Default,,0000,0000,0000,,the
Dialogue: 0,0:56:18.35,0:56:21.58,Default,,0000,0000,0000,,performance of the test of interest
Dialogue: 0,0:56:21.58,0:56:23.08,Default,,0000,0000,0000,,and the gold standard he's y
Dialogue: 0,0:56:23.08,0:56:26.02,Default,,0000,0000,0000,,t
Dialogue: 0,0:56:26.02,0:56:28.26,Default,,0000,0000,0000,,better out there to buy two table
Dialogue: 0,0:56:28.26,0:56:30.12,Default,,0000,0000,0000,,to be able to represent
Dialogue: 0,0:56:30.12,0:56:34.47,Default,,0000,0000,0000,,how those the study participants a sort\Nthemselves based on how the test of
Dialogue: 0,0:56:34.47,0:56:35.34,Default,,0000,0000,0000,,interested
Dialogue: 0,0:56:35.34,0:56:37.91,Default,,0000,0000,0000,,and how the gold standard label
Dialogue: 0,0:56:37.91,0:56:40.87,Default,,0000,0000,0000,,across the top you always
Dialogue: 0,0:56:40.87,0:56:44.13,Default,,0000,0000,0000,,you always uh... the columns are\Nrepresented by those that tested
Dialogue: 0,0:56:44.13,0:56:45.01,Default,,0000,0000,0000,,positive
Dialogue: 0,0:56:45.01,0:56:48.02,Default,,0000,0000,0000,,for the disease based on the gold\Nstandard medical center
Dialogue: 0,0:56:48.02,0:56:50.02,Default,,0000,0000,0000,,work theoretically calling a\Nhundred-percent
Dialogue: 0,0:56:50.02,0:56:54.68,Default,,0000,0000,0000,,therefore each identified those in the\Npopulation who have the disease
Dialogue: 0,0:56:54.68,0:56:57.02,Default,,0000,0000,0000,,and those that test negative by the gold\Nstandard
Dialogue: 0,0:56:57.02,0:57:00.41,Default,,0000,0000,0000,,will be in the second call
Dialogue: 0,0:57:00.41,0:57:02.42,Default,,0000,0000,0000,,but all of these populations
Dialogue: 0,0:57:02.42,0:57:03.08,Default,,0000,0000,0000,,in the study
Dialogue: 0,0:57:03.08,0:57:07.05,Default,,0000,0000,0000,,there will be some of those that also\Ntested positive based on the
Dialogue: 0,0:57:07.05,0:57:11.74,Default,,0000,0000,0000,,experimental test you're interested
Dialogue: 0,0:57:11.74,0:57:14.62,Default,,0000,0000,0000,,and some that test lead
Dialogue: 0,0:57:14.62,0:57:16.09,Default,,0000,0000,0000,,and sometimes they're going to agree
Dialogue: 0,0:57:16.09,0:57:18.70,Default,,0000,0000,0000,,with what the gold standard says
Dialogue: 0,0:57:18.70,0:57:22.27,Default,,0000,0000,0000,,such as inbox a and boxy
Dialogue: 0,0:57:22.27,0:57:24.02,Default,,0000,0000,0000,,sometimes they're going to disagree
Dialogue: 0,0:57:24.02,0:57:25.100,Default,,0000,0000,0000,,with what the gold standard set
Dialogue: 0,0:57:25.100,0:57:29.24,Default,,0000,0000,0000,,based on box b and boxy
Dialogue: 0,0:57:29.24,0:57:32.02,Default,,0000,0000,0000,,for simplicity safe keep in mind that we\Narent we are
Dialogue: 0,0:57:32.02,0:57:36.46,Default,,0000,0000,0000,,assuming that the gold standard is a\Nhundred percent
Dialogue: 0,0:57:36.46,0:57:39.04,Default,,0000,0000,0000,,so we're just gonna assume that whatever\Nthe gold standard said is true
Dialogue: 0,0:57:39.04,0:57:42.90,Default,,0000,0000,0000,,and we're comparing it against test of\Ninterest
Dialogue: 0,0:57:42.90,0:57:46.07,Default,,0000,0000,0000,,each of these boxes have different names\Nthat are going to come get introduced to
Dialogue: 0,0:57:46.07,0:57:47.08,Default,,0000,0000,0000,,you
Dialogue: 0,0:57:47.08,0:57:48.59,Default,,0000,0000,0000,,does that work
Dialogue: 0,0:57:48.59,0:57:53.73,Default,,0000,0000,0000,,disease are are labeled correctly by\Nexperimental tasks
Dialogue: 0,0:57:53.73,0:58:00.20,Default,,0000,0000,0000,,as having the disease based on the gold\Nstandard are called true positives
Dialogue: 0,0:58:00.20,0:58:01.86,Default,,0000,0000,0000,,their inbox it
Dialogue: 0,0:58:01.86,0:58:05.34,Default,,0000,0000,0000,,those that are correctly labelled as not\Nhaving the disease by the experimental
Dialogue: 0,0:58:05.34,0:58:12.70,Default,,0000,0000,0000,,test relative to the gold standard are\Nconsidered true naked
Dialogue: 0,0:58:12.70,0:58:13.09,Default,,0000,0000,0000,,those that are
Dialogue: 0,0:58:13.09,0:58:17.07,Default,,0000,0000,0000,,falsely labeled as having the ditsy
Dialogue: 0,0:58:17.07,0:58:18.30,Default,,0000,0000,0000,,based on the tax
Dialogue: 0,0:58:18.30,0:58:21.72,Default,,0000,0000,0000,,but they actually build because the gold\Nstandard sent me one
Dialogue: 0,0:58:21.72,0:58:26.56,Default,,0000,0000,0000,,are called false positives
Dialogue: 0,0:58:26.56,0:58:30.69,Default,,0000,0000,0000,,and those that are falsely labeled at\Nnot having the disease
Dialogue: 0,0:58:30.69,0:58:32.35,Default,,0000,0000,0000,,when they actually do
Dialogue: 0,0:58:32.35,0:58:34.68,Default,,0000,0000,0000,,are called false names
Dialogue: 0,0:58:34.68,0:58:36.77,Default,,0000,0000,0000,,the standard nomenclature
Dialogue: 0,0:58:36.77,0:58:38.01,Default,,0000,0000,0000,,gotta remember it
Dialogue: 0,0:58:38.01,0:58:40.06,Default,,0000,0000,0000,,fairly straightforward false positives\Nfalse names
Dialogue: 0,0:58:40.06,0:58:44.20,Default,,0000,0000,0000,,these areas of agreement these are the\Nareas of disagreement
Dialogue: 0,0:58:44.20,0:58:46.05,Default,,0000,0000,0000,,what we're going to do no
Dialogue: 0,0:58:46.05,0:58:47.01,Default,,0000,0000,0000,,is picked up
Dialogue: 0,0:58:47.01,0:58:49.01,Default,,0000,0000,0000,,with our
Dialogue: 0,0:58:49.01,0:58:52.07,Default,,0000,0000,0000,,figuring out how we use this to define\Ntest characteristics
Dialogue: 0,0:58:52.07,0:58:55.23,Default,,0000,0000,0000,,so let's take a five minute break
Dialogue: 0,0:58:55.23,0:58:57.36,Default,,0000,0000,0000,,and then we will come back and talk\Nabout
Dialogue: 0,0:58:57.36,9:59:59.99,Default,,0000,0000,0000,,the test characteristics better rise\Nfrom this to my teeth