Dear colleagues
Ping Li and I have now completed our analysis of the scoring of comments
from Case 30 to 50, and have written a short paper about this. We will
continue with the present breakdown of comments into components, which will
be scored 'blind' by independent assessors - the advantages of this seem to
outweigh the disadvantages. However we will make two modifications to the
previous system of adding together component scores to give a total comment
score for each registered participant.
1. 'Telephone and discuss' has always achieved a positive score (mean 1.2;
range 0.8 - 2.0). From now on, in assigning comment scores we will subtract
1.2 from the scoring of this component. Participants who make this comment
will therefore only achieve a positive score if the assessors all felt that
this is appropriate or highly appropriate.
2. The scoring of comments has undoubtedly favoured participants who
include many components in their comments, for example suggesting more than
one outcome, and a range of further investigations. This is unfair to those
participants who include only a few but highly relevant components. So as
well as calculating a 'total comment score', we will also calculate a 'mean
score per component' for each registered participant. This will favour the
'short but succinct' commenters and it will be interesting to see how the
two assessment methods compare with each other (find out after Case 75, if
I last that long).
In the meantime, could I ask you to react to these Cases as much as
possible as you would do in your own Departments, and try to keep your
comments to a maximum of two lines wherever possible. Apart from anything
else, it makes my job much easier!
To start the next round of 'Cases for Comment', this one arrived on my desk
last Saturday morning.
A 36 year old lady, seeing her Family Doctor. Serum results were
Free T4: 9.3 pmol/L (10 - 26)
Free T3: 3.4 pmol/L (3.7 - 6.9)
TSH: 1.8 mU/L (0.25 - 5.5)
Clinical information was 'Previous borderline free T4 and normal TSH.
Significance?
Results from two months previously were
Free T4: 9.8 pmol/L
TSH: 1.2 mU/L
FSH: 5.8 U/L (follicular phase, 2 - 11)
LH: 4.8 U/L (follicular phase 1 - 10)
Testosterone: 0.2 nmol/L (0.3 - 2.9)
Oestradiol: 37 pmol/L (follicular phase 75 - 260)
Clinical information then was 'depressed, decreased libido', and a repeat
in 6 weeks had been suggested.
The Family Doctor's surgery is closed for the weekend.
Comment and/ or other action directly to me please
([log in to unmask], not to the mailbase.
Best wishes
Gordon Challand
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