73 lines
10 KiB
JSON
73 lines
10 KiB
JSON
[
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{
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"externalId":"dyn-gold-dka","version":3,"baseBlueprintVersion":2,
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"qualityStandardVersion":3,"isPublished":true,
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"caseFamilies":[
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{"id":"dka-fnd-infection","baseFamilyId":"dka-infection","difficultyTier":"foundation","nominalElo":850,"stemTemplate":"The combination of hyperglycemia, ketonemia, and an anion-gap metabolic acidosis confirms diabetic ketoacidosis."},
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{"id":"dka-fnd-new","baseFamilyId":"dka-new-onset","difficultyTier":"foundation","nominalElo":850,"stemTemplate":"The patient is clinically volume depleted, and there is no evidence of heart or kidney failure."},
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{"id":"dka-std-pump","baseFamilyId":"dka-pump-failure","difficultyTier":"standard","nominalElo":1050,"stemTemplate":"The emergency team prepares simultaneous cardiac monitoring and repeat electrolyte measurements."},
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{"id":"dka-std-infection","baseFamilyId":"dka-infection","difficultyTier":"standard","nominalElo":1050,"stemTemplate":"The urinary infection will require treatment, but the team must first sequence the metabolic resuscitation correctly."},
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{"id":"dka-adv-new","baseFamilyId":"dka-new-onset","difficultyTier":"advanced","nominalElo":1250,"stemTemplate":"Although the measured serum potassium is not low, the patient has had substantial urinary potassium losses and has not yet received insulin."},
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{"id":"dka-adv-pump","baseFamilyId":"dka-pump-failure","difficultyTier":"advanced","nominalElo":1250,"stemTemplate":"A family member asks whether reconnecting the pump alone will reverse the acute physiology."},
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{"id":"dka-exp-infection","baseFamilyId":"dka-infection","difficultyTier":"expert","nominalElo":1450,"stemTemplate":"The patient received one antibiotic dose at urgent care; this does not explain the persistent shock physiology or alter the immediate metabolic priority."},
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{"id":"dka-exp-pump","baseFamilyId":"dka-pump-failure","difficultyTier":"expert","nominalElo":1450,"stemTemplate":"Point-of-care ultrasound shows a small collapsible inferior vena cava and preserved left ventricular systolic function."}
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]
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},
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{
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"externalId":"dyn-gold-af","version":3,"baseBlueprintVersion":2,
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"qualityStandardVersion":3,"isPublished":true,
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"caseFamilies":[
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{"id":"af-fnd-sepsis","baseFamilyId":"af-sepsis","difficultyTier":"foundation","nominalElo":850,"stemTemplate":"The hypotension and confusion began with the rapid rhythm and are attributed to the tachyarrhythmia."},
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{"id":"af-fnd-edema","baseFamilyId":"af-pulmonary-edema","difficultyTier":"foundation","nominalElo":850,"stemTemplate":"The patient has a pulse but has acute pulmonary edema and shock caused by the rapid rhythm."},
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{"id":"af-std-ischemia","baseFamilyId":"af-ischemia","difficultyTier":"standard","nominalElo":1050,"stemTemplate":"The exact duration of atrial fibrillation is unknown."},
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{"id":"af-std-sepsis","baseFamilyId":"af-sepsis","difficultyTier":"standard","nominalElo":1050,"stemTemplate":"Antibiotics and source control are underway, but perfusion continues to deteriorate as the ventricular rate rises."},
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{"id":"af-adv-edema","baseFamilyId":"af-pulmonary-edema","difficultyTier":"advanced","nominalElo":1250,"stemTemplate":"The patient took the usual beta blocker this morning, and additional atrioventricular nodal blockade could worsen the low-output state."},
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{"id":"af-adv-ischemia","baseFamilyId":"af-ischemia","difficultyTier":"advanced","nominalElo":1250,"stemTemplate":"A postoperative hemoglobin measurement is mildly decreased but stable and does not account for the abrupt hemodynamic change."},
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{"id":"af-exp-sepsis","baseFamilyId":"af-sepsis","difficultyTier":"expert","nominalElo":1450,"stemTemplate":"A prior ECG showed sinus rhythm with a normal PR interval; the current tracing has no pre-excitation and the instability persists after a cautious fluid challenge."},
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{"id":"af-exp-ischemia","baseFamilyId":"af-ischemia","difficultyTier":"expert","nominalElo":1450,"stemTemplate":"Bedside echocardiography shows no pericardial effusion or right ventricular dilation, narrowing the cause of shock to the rapid atrial arrhythmia."}
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]
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},
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{
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"externalId":"dyn-gold-pyelo-pregnancy","version":3,"baseBlueprintVersion":2,
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"qualityStandardVersion":3,"isPublished":true,
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"caseFamilies":[
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{"id":"pyelo-fnd-classic","baseFamilyId":"pyelo-classic","difficultyTier":"foundation","nominalElo":850,"stemTemplate":"The fever and costovertebral-angle tenderness distinguish this upper urinary tract infection from uncomplicated cystitis."},
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{"id":"pyelo-fnd-recurrent","baseFamilyId":"pyelo-recurrent","difficultyTier":"foundation","nominalElo":850,"stemTemplate":"There is no drug allergy, and renal function is normal."},
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{"id":"pyelo-std-systemic","baseFamilyId":"pyelo-systemic","difficultyTier":"standard","nominalElo":1050,"stemTemplate":"There is no evidence of obstructing nephrolithiasis on bedside assessment."},
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{"id":"pyelo-std-classic","baseFamilyId":"pyelo-classic","difficultyTier":"standard","nominalElo":1050,"stemTemplate":"The patient can take oral medication but remains febrile and systemically ill."},
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{"id":"pyelo-adv-recurrent","baseFamilyId":"pyelo-recurrent","difficultyTier":"advanced","nominalElo":1250,"stemTemplate":"The earlier urine isolate was susceptible to nitrofurantoin, but susceptibility does not overcome inadequate renal parenchymal penetration."},
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{"id":"pyelo-adv-systemic","baseFamilyId":"pyelo-systemic","difficultyTier":"advanced","nominalElo":1250,"stemTemplate":"Mild uterine irritability resolves with hydration, and there is no indication for delivery."},
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{"id":"pyelo-exp-classic","baseFamilyId":"pyelo-classic","difficultyTier":"expert","nominalElo":1450,"stemTemplate":"A preliminary culture reports a gram-negative rod; definitive susceptibilities will not be available until tomorrow."},
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{"id":"pyelo-exp-systemic","baseFamilyId":"pyelo-systemic","difficultyTier":"expert","nominalElo":1450,"stemTemplate":"The lactate and respiratory rate raise concern for evolving maternal sepsis, making disposition as important as antibiotic spectrum."}
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]
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},
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{
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"externalId":"dyn-gold-sah","version":3,"baseBlueprintVersion":2,
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"qualityStandardVersion":3,"isPublished":true,
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"caseFamilies":[
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{"id":"sah-fnd-exertion","baseFamilyId":"sah-exertion","difficultyTier":"foundation","nominalElo":850,"stemTemplate":"The sudden maximal-at-onset headache and meningismus are classic warning features for subarachnoid hemorrhage."},
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{"id":"sah-fnd-sentinel","baseFamilyId":"sah-sentinel","difficultyTier":"foundation","nominalElo":850,"stemTemplate":"This is a first thunderclap headache, not a recurrence of a previously evaluated migraine syndrome."},
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{"id":"sah-std-focal","baseFamilyId":"sah-focal","difficultyTier":"standard","nominalElo":1050,"stemTemplate":"The patient is stable enough for immediate diagnostic imaging."},
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{"id":"sah-std-exertion","baseFamilyId":"sah-exertion","difficultyTier":"standard","nominalElo":1050,"stemTemplate":"The absence of persistent focal weakness does not reduce the urgency of excluding hemorrhage."},
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{"id":"sah-adv-sentinel","baseFamilyId":"sah-sentinel","difficultyTier":"advanced","nominalElo":1250,"stemTemplate":"The presentation occurred recently enough that the initial imaging strategy has high diagnostic yield, but a negative result must still be interpreted in clinical context."},
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{"id":"sah-adv-focal","baseFamilyId":"sah-focal","difficultyTier":"advanced","nominalElo":1250,"stemTemplate":"The partial third-nerve finding raises concern for an aneurysmal source but does not replace the initial study for acute blood."},
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{"id":"sah-exp-exertion","baseFamilyId":"sah-exertion","difficultyTier":"expert","nominalElo":1450,"stemTemplate":"A nonfocal examination and transient improvement after analgesia are potentially misleading and should not alter the first diagnostic step."},
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{"id":"sah-exp-sentinel","baseFamilyId":"sah-sentinel","difficultyTier":"expert","nominalElo":1450,"stemTemplate":"Family history increases pretest probability, while the choice between subsequent lumbar puncture and angiographic evaluation depends on the result and timing of the initial study."}
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]
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},
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{
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"externalId":"dyn-gold-arr","version":3,"baseBlueprintVersion":2,
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"qualityStandardVersion":3,"isPublished":true,
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"caseFamilies":[
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{"id":"arr-fnd-cardio","baseFamilyId":"arr-cardiovascular","difficultyTier":"foundation","nominalElo":850,"stemTemplate":"Calculate the arithmetic difference between the two event rates rather than a relative measure."},
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{"id":"arr-fnd-infection","baseFamilyId":"arr-infection","difficultyTier":"foundation","nominalElo":850,"stemTemplate":"The requested measure should be reported in percentage points."},
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{"id":"arr-std-readmit","baseFamilyId":"arr-readmission","difficultyTier":"standard","nominalElo":1050,"stemTemplate":"Do not convert the result to number needed to treat unless specifically asked."},
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{"id":"arr-std-cardio","baseFamilyId":"arr-cardiovascular","difficultyTier":"standard","nominalElo":1050,"stemTemplate":"The trial reports sufficient data to calculate absolute and relative effects directly."},
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{"id":"arr-adv-infection","baseFamilyId":"arr-infection","difficultyTier":"advanced","nominalElo":1250,"stemTemplate":"A secondary table emphasizes a large relative reduction, but the question asks for the absolute treatment effect."},
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{"id":"arr-adv-readmit","baseFamilyId":"arr-readmission","difficultyTier":"advanced","nominalElo":1250,"stemTemplate":"The intervention has similar follow-up completeness in both groups, so no adjustment for attrition is needed."},
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{"id":"arr-exp-cardio","baseFamilyId":"arr-cardiovascular","difficultyTier":"expert","nominalElo":1450,"stemTemplate":"The authors additionally report an adjusted hazard ratio; that time-to-event estimate is not needed for this requested absolute measure."},
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{"id":"arr-exp-readmit","baseFamilyId":"arr-readmission","difficultyTier":"expert","nominalElo":1450,"stemTemplate":"Cost-effectiveness and relative-risk results are presented as distractors, but neither changes the calculation from the observed event proportions."}
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]
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}
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]
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