Misdiagnosis of OADs in community patients with inhaled prescription medication for shortness of breath
Bibliographic record
Abstract
<b>Background:</b> Obstructive airway diseases (OADs) mainly asthma and chronic obstructive pulmonary disease (COPD) are the two common diseases associated with shortness of breath (SOB) symptoms. <b>Objective:</b> To compare physician-diagnosis of asthma and COPD among community patients with SOB and with prescribed inhalers to spirometrically-defined diagnosis or expert consensus based on ATS/ERS standard guidelines. <b>Method:</b> 328 of eligible SOB patients were identified through community pharmacies in Edmonton and Saskatoon, in Canada. Full pre and post-bronchodilator PFT were performed and diagnosis subsequently determined based on guideline-derived criteria approved by three expert physicians. <b>Result:</b> 45.4% of patients had a diagnosis of asthma and 29.6% COPD. Subjects were Caucasian (86%), female (57%), and had a postsecondary education (49%) and with a median age of 50 years. Only 40% of patients had prior PFT performed to provide a diagnosis from a family-care physician. Self-reported medications for management included SABA (74.1%), inhaled corticosteroids (28.0%), and combination inhaler products (35%). Measures of agreement ( that is, sensitivity (Sens) and specificity(Spec)) of physician-diagnosis with guideline-derived diagnosis were: asthma (Sens=71%, Spec=51%, Kappa=0.22, p=0.001), and COPD (Sens=28%.; Spec=95%, Kappa=0.28, p=0.001). <b>Conclusion:</b> Significant disagreement exists between physician-diagnosis and guideline-derived diagnosis among management of community patients with SOB symptoms. Most patients are prescribed inhalers without a PFT diagnostic workup. This may be in part due to the inadequate understanding of PFT interpretation and usage by family-care physicians.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".