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trnka t1_j0emdr8 wrote

Very cool! I worked closely our doctors on ML features at a telemedicine startup, let me check some of the things I know about:

- What's the most effective antibiotic for a UTI? -> "effective" was a poor word choice on my part, it gave 1 drug that we didn't use, 1 that was a last line of defense type of drug, and then a drug class

- What's the best first-line antibiotic for a UTI -> agreed with our clinical best practices (Nitrofurantoin)

- I tried asking for when to diagnose bacterial vs viral common colds if a lab test can't be done - no results (best practice was symptoms not improving >10 days to treat as bacterial)

- "When is tamiflu effective?" If I remember right, our guidelines were first day of infection or first two days if the patient's immunocompromised, lives with someone immunocompromised, or works in healthcare. The system was sorta right: "Oseltamivir (Tamiflu) is effective for the treatment and prevention of influenza in adults, adolescents, and children, and early initiation of treatment provides greater clinical benefits."

- How does coffee affect blood pressure? I remembered it increased after drinking in a BP test we ran. That showed up in the results, but the results had both 1) studies about immediate effects and 2) studies about long-term effects which have different conclusions.

When the query fails, I wish it wouldn't just delete it - it'd be nice to have it still there so I can share it with you, or for myself to revise the query. I also had one query get "stuck" but all the steps transitioned to checked.

If you can get access to a site like UpToDate, many of our doctors used that for clinical best practices. Very few searched the medical literature directly.

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I'll share with some of my doctor friends and hopefully they'll give you actual medical feedback rather than the secondhand knowledge I have.

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tmblweeds OP t1_j0hg7su wrote

Super helpful! This broadly aligns with other feedback I've gotten, that I should be focusing on guidelines in addition to/instead of clinical research.

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trnka t1_j0hr6zn wrote

Yeah our doctors spent a lot of time building and revising clinical guidelines for our practice.

I'm not sure what your background is, but some tips from working with them on clinical guidelines:

  • There were some guidelines that were generally-accepted best practices in medicine, but it was more common to have clinic-specific guidelines
  • My team ran into some resistance to the idea of ML-created guidelines. Physicians were more receptive to technology that assisted them in creating guidelines
  • Many guidelines are aspirational, like when to order lab tests. Many patients just won't get the tests, or the test results will come back after the current condition has resolved. Likewise, if you're worried about a patient taking the antibiotic to term, it may be better to use a 1-dose second-line antibiotic rather than a multi-dose first-line antibiotic. In the long term I expect that clinical guidelines will adapt somewhat to patient adherence; they aren't a one-time thing. Plus research changes too.
  • For any evidence, there needs to be vetting of how it's gathered, like whether it's a proper randomized control trial, how the statistics are done, how the study is designed, what population was studied, etc
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tmblweeds OP t1_j0ieog3 wrote

Ah yeah I wasn't thinking necessarily about creating guidelines with ML—more like highlighting/synthesizing relevant excerpts from existing guidelines (e.g. NICE, American College of Cardiology, etc.). But I didn't know that individual clinics had their own guidelines in addition to the "official" ones).

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take_eacy t1_j0hh73q wrote

Yes, as an MD, I agree with the points made above

Uptodate is a widely used summary of guidelines (doctors are paid to summarize and synthesize the latest research studies). Widely used is almost an understatement honestly - whke your doctor steps outside or has to look something up, it is one of the top resources (if not like #1 though nobody likes to admit it) since it's such a great aggregator.

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