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Sources in Earlydoc

How is Earlydoc made?

Earlydoc’s medical information and algorithms are based on several types of sources:

  • Scientific research
  • Medical handbooks
  • Existing triage-protocols
  • Experience of (family) doctors
  • Testing with patients

Check development has a number of stages

  1. Defining the triage and diagnostic criteria
  2. Testing the system locally for errors and usability
  3. Testing the system meticulously with doctors using different scenarios
  4. Testing the system with end-users
  5. Continuous revising to implement the latest medical insights

Triage:

Determining the level of urgency, in triage, we use four levels of urgency

  1. Emergency/very urgent - the user needs to contact the doctors office immediately or call the number for emergency services
  2. Urgent - the user needs to contact the doctors office today
  3. Not urgent - the user should make an appointment with the doctor on a normal weekday
  4. Selfcare - the user doesn’t need to be seen by or contact a doctor, the complaints are likely to go away on their own in a few days

For each level of urgency a number of criteria is defined. These can be singular or combined criteria. After the triage part of the check, the answers are matched with the all the triage criteria. The criterium for the highest level of urgency determines Earlydoc’s triage advice.

To give the best possible advice about the urgency of the users complaints, Earlydoc combines several existing triage systems. We check all triage protocols with current research, handbooks and experience of doctors to make sure the triage system corresponds with the current medical practice.

Sources for triage-criteria:

  • NHG TriageWijzer (triage system)
  • Australian Triage Scale: triage scale used in Australia and New Zealand to assess urgency

NHG: Dutch College of General Practitioners

Doctors first thoughts on causes:

For assessing the doctors first thoughts on possible causes for the complaints, we first define important and specific symptoms for each condition. The diseases and symptoms are weighted to account for incindence and their capability to distinguish between diseases. In creating the system for differentiating between possible causes we use as much current scientific medical literature. To make sure the system corresponds with current medical practice we always test and revise the checks with doctors.

Sources for diagnostic logic, information and tips:

  • UpToDate (evidence based clinical decision support, www.uptodate.com)
  • NHG-standards (guidelines from the NHG based on research)
  • Medical research
  • Diagnostiek van de alledaagse klachten, T.O.H. de Jongh, 2005
  • Oxford Handbook of Clinical Medicine, 8th Edition
  • Oxford Handbook of Clinical Diagnosis, 2nd Edition

General sources:

  • Diagnostiek van alledaagse klachten, T.O.H. de Jongh, 2005*
  • Oxford handbook of clinical diagnosis, 2nd edition
  • Oxford handbook of clinical medicine, 8th edition
  • NHG TriageWijzer (triage system)
  • Incidence numbers
    • Nationaalkompas.nl
    • CPB (Netherlands Bureau for Economic Policy Analysis)
    • CBS (Statistics Netherlands)

*Medical handbook about diagnosing everyday complaints

Specific sources per complaint check:

Headache

  • UpToDate:
    • Cluster headache: Epidemiology, clinical features, and diagnosis
    • Evaluation of headache in adults
    • Medication overuse headache: Etiology, clinical features and diagnosis
    • Primary stabbing headache
    • Overview of chronic daily headache
    • Pathophysiology, clinical manifestations, and diagnosis of migraine in adults
    • Evaluation of the adult with headache in the emergency department
    • Tension-type headache in adults: Pathophysiology, clinical features, and diagnosis
    • Patient information
      • Headache
      • Headache causes and diagnosis
      • Headache treatment
  • translation missing: en.nhg_standard
    • Hoofdpijn (headache) - M19
  • Diagnostiek van de alledaagse klachten, T.O.H. de Jongh, 2005
    • Chapter 'Hoofdpijn', page 189
  • Oxford Handbook of Clinical Medicine, 8th Edition
    • Headache, pag. 460-461
    • Migraine, pag. 462-463
    • Subarachnoid haemorrhage (SAH), pag. 482-483
  • Oxford Handbook of Clinical Diagnosis, 2nd Edition
    • Headache
      • Acute, new onset, pag. 582
      • Subacute onset, pag. 584
      • Chronic and recurrent, pag. 586

Cough

  • UpToDate:
    • Acute bronchitis in adults
    • The common cold in adults: Treatment and prevention
    • The common cold in adults: Diagnosis and clinical features
    • Patient information:
      • The common cold in adults
      • Cough, runny nose and the common cold
  • translation missing: en.nhg_standard:
    • Acuut hoesten (acute cough) - M78
    • Astma bij volwassenen (asthma in adults) - M27
    • COPD - M26
  • Diagnostiek van de alledaagse klachten, T.O.H. de Jongh, 2005
    • Hoofdstuk "Hoesten', pag. 357
  • Oxford Handbook of Clinical Medicine, 8th Edition
    • Asthma, pag. 172-173
    • COPD, pag. 176-177
  • Oxford Handbook of Clinical Diagnosis, 2nd Edition
    • Cough with sputum, pag. 298
    • Persistent dry cough with no sputum, pag. 300

Fever

  • UpToDate:
    • Clinical manifestations of seasonal influenza in adults
    • Treatment of seasonal influenza in adults
    • Diagnosis of seasonal influenza in adults
    • Epidemiology of influenza
    • Prevention of seasonal inluenza in adults
    • The common cold in adults: Treatment and prevention
    • The common cold in adults: Diagnosis and clinical features
    • Approach to the adult with fever of unknown origin
    • Etiologies of fever of unkown origin in adults
    • Pathofysiology and treatment of fever in adults
  • translation missing: en.nhg_standard:
    • Influenza en influenzavaccinatie (influenza and influenza vaccination) - M35
    • Acute diarree (acute diarrhea) - M34
  • Diagnostiek van de alledaagse klachten, T.O.H. de Jongh, 2005:
    • Chapter "Koorts bij volwassenen" (fever in adults), pag. 51
  • Oxford Handbook of Clinical Medicine, 8th Edition:
    • Influenza, pag. 402-403
    • Pyrexia of unknown origin (PUO), pag. 386
  • Oxford Handbook of Clinical Diagnosis, 2nd Edition:
    • Fever, pag. 104

Sore Throat

  • UpToDate:
    • Approach to diagnosis of acute infectious pharyngitis in children and adolescents
    • Evaluation of acute pharyngitis in adults
    • Symptomatic relief of sore throat in children and adolescents
  • translation missing: en.nhg_standard:
    • Acute keelpijn (acute sore throat) - M11
  • Diagnostiek van de alledaagse klachten, T.O.H. de Jongh, 2005:
    • Chapter "Keelpijn' (sore throat), pag. 215
  • Oxford Handbook of Clinical Medicine, 8th Edition:
    • GORD, pag. 244
  • Oxford Handbook of Clinical Diagnosis, 2nd Edition:
    • Hoarseness, pag. 302

Abdominal Pain

  • UpToDate:
    • Clinical manifestations and diagnosis of irritable bowel syndrome
    • Diagnostic approach to abdominal pain in adults
    • Evaluation of the adult with abdominal pain in the emergency department
    • Functional dyspepsia
    • History and physical examination in adults with abdominal pain
    • Approach to the adult with acute diarrhea in developed countries
    • Epidemiology and causes of acute diarrhea in deveoped countries
    • Patient information:
      • Food poisoning
      • Lactose intolerance
  • translation missing: en.nhg_standard:
    • Acute diarree (acute diarrhea) - M34
    • Diverticulitis - M99
    • Maagklachten (abdominal complaints)- M36
    • Obstipatie (constipation) - M94
    • PDS - M71
    • Voedselovergevoeligheid (hypersensitivity to food) - M47
    • Urineweginfecties (urinary tract infections) - M05
  • Diagnostiek van de alledaagse klachten, T.O.H. de Jongh, 2005:
    • Chapter "Buikpijn, acute' (acute abdominal pain), pag. 451
    • Chapter "Buikpijn, chronische' (acute abdominal pain), pag. 471
  • Oxford Handbook of Clinical Medicine, 8th Edition:
    • Dyspepsia & peptic ulcer disease, pag. 242-243
    • GORD, pag. 244-245
    • Diarrhoea, pag. 246-247
    • Constipation, pag. 248-249
    • Irritable bowel syndrome, pag. 276-277
    • Urinary tract infection, pag. 292-293
    • Sexually transmitted infections/diseases, pag. 416-417
  • Oxford Handbook of Clinical Diagnosis, 2nd Edition:
    • Vomiting, pag. 346/li>
    • Vomiting with abdominal pain and fever, pag. 362
    • Vomiting with abodminal pain alone (unrelated to food and no fever):
      • Non-metabolic causes, pag. 364
      • Metabolic causes, pag. 366
    • Acute pain in the upper abdomen, pag. 390
    • Acute central abdominal pain, pag. 392
    • Acute lateral abdominal pain, pag. 394
    • Acute lower central abdominal pain, pag. 396
    • Constipation, pag. 414

Back Pain

  • UpToDate:
    • Back pain in children and adolescents: Overview of causes
    • Approach to the diagnosis and evaluation of low back pain in adults
    • Occupational low back pain:
      • Evaluation
      • Treatment
    • Exercise-based therapy for low back pain
    • Clinical manifestations and diagnosis of aortic dissection
    • Ruptured abdominal aortic aneurysm
    • Patient information:
      • Low back pain in adults
  • translation missing: en.nhg_standard:
    • Aspecifieke lagerugpijn (non-specific back pain) - M54
  • Diagnostiek van de alledaagse klachten, T.O.H. de Jongh, 2005:
    • Chapter "Rugpijn, lage', pag. 675
  • Oxford Handbook of Clinical Medicine, 8th Edition:
    • Back pain, pag. 544-545
  • Oxford Handbook of Clinical Diagnosis, 2nd Edition:
    • Pain or limitation of movement of the back: with sudden onset over seconds to hours originally, pag. 546
    • Pain or limitation of movement of the back: with onset over days to months originally, pag. 548
    • Pain or limitation of movement of the back: with onset over years, pag. 550
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