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Clinical · Bloodwork · continued

Building a sensible monitoring schedule with your prescriber posts 61–90

This is a continuation of a long topic, addressed by post number rather than by page. Start at post 1.

YA
y.adebayoTL221 Dec 2024#61

An update on my earlier building a sensible monitoring schedule post: the pattern held for another six weeks and then stopped, which I did not predict and cannot explain.

18 likes 19mo
MH
ms_hollowayTL4Mass spectrometrist21 Dec 2024#62

Post #60 answers the question as asked. The question underneath it is different.

Time of day: some biomarkers vary across the day. Cortisol in the morning differs from cortisol in the evening. Comparing results from different times of day is comparing things that are not the same.

7 likes 19mo
NS
n.silvaTL221 Dec 2024#63

Trying to state the building a sensible monitoring schedule position in a way that someone who disagrees would recognise as fair, because I do not think the version in this thread passes that test.

0 likes 19mo
SL
s.leclercTL4 Moderator21 Dec 2024#64
c.boateng, post #36: Coming back to post #32, because the follow-up matters more than the original answer. I disagree with the framing of building a sensible monitoring schedule above, and I think it is a substantive disagreement rather than a terminological one. Setting out why, so it can be checked. The reasoning depends on an assumption that is doing a… Go to post

Building a sensible monitoring schedule is worth one more sentence than it usually gets, and the sentence is the one about how the number was arrived at.

0 likes in reply to #36 19mo
RB
r.bruunTL221 Dec 2024#65
TH
TL4_HalvorsenTL4Leader · Journal club21 Dec 2024#66

Narrowing post #63, because the general version has more than one answer.

A trend needs at least three points to be a trend. Two points are a line and a line through noise is still a line.

I have kept the units in throughout, for the obvious reason.

12 likes 19mo
CC
ch.correiaTL221 Dec 2024#67

The strongest argument against my own position on building a sensible monitoring schedule, stated as well as I can state it, since nobody else has yet.

1 like 19mo
DV
dr.villanuevaTL3Physician21 Dec 2024#68

Repeat before acting is standard practice for an isolated abnormal result on most analytes, and it is standard for a reason.

0 likes 19mo
JB
j.bhattacharyaTL221 Dec 2024#69
Ridgeway, post #2: Worth stating the null on building a sensible monitoring schedule before we explain it: the observation may be nothing. That possibility deserves a sentence and usually does not get one. Go to post

A note on scope: what I am saying about building a sensible monitoring schedule applies to the case in the first post and I would not extend it further without checking.

0 likes in reply to #2 19mo
SC
s.chowdhuryTL3Regular21 Dec 2024 · edited#70

Where the building a sensible monitoring schedule reasoning breaks down for me is the step from the group result to the individual case. That step is almost never argued for.

17 likes 19mo
AR
a.reyesTL421 Dec 2024#71
KD
k.dahlbergTL221 Dec 2024#72
excursion_check, post #42: Adding the measurement that post #41 says would settle it. Practical answer on building a sensible monitoring schedule, since the theoretical one is upthread: do the simplest check first, write down the result, and only then decide whether the complicated explanation is needed. It usually is not. Go to post

Nobody has said the unglamorous part of building a sensible monitoring schedule yet, so: most of the variation is explained by things that are boring to write about and easy to check.

0 likes in reply to #42 19mo
OB
owen.bradyTL4 Moderator21 Dec 2024#73

My experience of building a sensible monitoring schedule contradicts the reply above. I am posting it as a data point rather than as a refutation, because one person's experience is exactly that.

4 likes 19mo
RS
r.serranoTL221 Dec 2024#74

Worth separating two things that post #72 runs together.

Time of day: some biomarkers vary across the day. Cortisol in the morning differs from cortisol in the evening. Comparing results from different times of day is comparing things that are not the same.

Posted with less confidence than the sentence structure implies.

13 likes 19mo
MH
ms_hollowayTL4Mass spectrometrist21 Dec 2024#75
mira.patel, post #35: Appreciated. The plain phrasing does more work here than a longer post would. Go to post

Reading back through the building a sensible monitoring schedule threads from last year, the same three questions come up every time and only one of them has ever been answered properly. That seems like a documentation gap rather than a knowledge gap.

19 likes in reply to #35 19mo
JE
j.erdoganTL221 Dec 2024#76

Building a sensible monitoring schedule is well covered in the tag pages, and the older discussions are better than the recent ones because they were argued out properly. Worth twenty minutes before adding to this one.

0 likes 19mo
DV
dr.villanuevaTL3Physician21 Dec 2024 · edited#77

Picking up post #74: that is the part I would want checked first.

Glycaemic markers integrate over different periods. A point glucose and a longer-term marker disagreeing is not a contradiction; it is two different questions.

I have said this before in a thread nobody could find, so it is worth repeating.

2 likes 19mo
SG
s.grimaldiTL222 Dec 2024#78

Saving this. It is the version I will quote when the question comes round again.

8 likes 19mo
SC
sourced_claimsTL3Regular22 Dec 2024#79
journalclub_wren, post #12: Where I part company with post #10, and it is a narrow parting. Marking my uncertainty on building a sensible monitoring schedule explicitly. I am confident about the direction, much less confident about the size, and not confident at all that it generalises past the case in the first post. Go to post

The version of building a sensible monitoring schedule that circulates here is a simplification of a simplification. It is not wrong, but it has lost the conditions under which it holds, and those conditions are where the interesting cases live.

0 likes in reply to #12 19mo
RZ
ro.zielinskiTL222 Dec 2024#80
MH
ms_hollowayTL4Mass spectrometrist22 Dec 2024#81

No disagreement from me. Posting only so the question does not look ignored.

0 likes 19mo
MI
m.ibarraTL222 Dec 2024#82

A trend needs at least three points to be a trend. Two points are a line and a line through noise is still a line.

That much is documented. The rest is how I have interpreted it.

20 likes 19mo
EF
endo_fellow_rkTL3Endocrinology fellow22 Dec 2024 · edited#83
mira.patel, post #35: Appreciated. The plain phrasing does more work here than a longer post would. Go to post

Time of day: some biomarkers vary across the day. Cortisol in the morning differs from cortisol in the evening. Comparing results from different times of day is comparing things that are not the same.

Where I would look next, rather than where I would stop.

8 likes in reply to #35 19mo
YA
y.adebayoTL222 Dec 2024#84
n.cabrera, post #17: The arithmetic in post #16 is right; the assumption feeding it is the part to check. A trend needs at least three points to be a trend. Two points are a line and a line through noise is still a line. I would want the raw data before agreeing with my own summary of it. Go to post

The claim about building a sensible monitoring schedule upthread is stronger than its source supports. I have read the source. The source says "associated with" and the post says "causes".

2 likes in reply to #17 19mo
AR
a.reyesTL4 Admin22 Dec 2024#85

Reframing building a sensible monitoring schedule slightly, because I think the disagreement is about the question rather than the answer. If the question is "does it happen", yes. If it is "how often", nobody here knows.

0 likes 19mo
JS
j.steinerTL222 Dec 2024#86

Repeat before acting is standard practice for an isolated abnormal result on most analytes, and it is standard for a reason.

I checked the source rather than the summary, and they differ.

27 likes 19mo
SL
s.leclercTL4 Moderator22 Dec 2024#87
PSkarbek, post #46: I came in to disagree and I am leaving without a disagreement. Go to post

Building a sensible monitoring schedule has a well-known answer and a correct answer, and the interesting work is establishing that they are the same. Nobody has done that here yet.

13 likes in reply to #46 19mo
LS
l.salinasTL222 Dec 2024#88

Narrowing post #85, because the general version has more than one answer.

My understanding of building a sensible monitoring schedule is a few years old and may have been superseded. If it has been, I would genuinely like to know rather than keep repeating it.

4 likes 19mo
BS
b.solbergTL222 Dec 2024#89

Glycaemic markers integrate over different periods. A point glucose and a longer-term marker disagreeing is not a contradiction; it is two different questions.

That is what the documentation says. What happens in practice is usually close.

21 likes 19mo
MC
m.coelhoTL222 Dec 2024 · edited#90

Adding a note of thanks rather than an opinion. I did not know most of that.

9 likes 19mo