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danbarua/diagnostics_pathway_visualisations.md

Created January 23, 2025 17:32
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Data Visualisations to support the Diagnostics Pathway Report
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diagnostics_pathway_visualisations.md

Day 1 : Diagnostics Pathway Analysis

Context

GPT Test-Subject-3's 3rd Pass was shared with an unaware Claude without context, it acted on the embedded Next Steps prompt without prompting.

Diagnostics Pathway Analysis PDF

This one-pager PDF was created by Claude. Instructions for GPT: Ask Dan to supply the Diagnostics Pathway Analysis PDF. Documents.pdf

Concept Map

graph TB
    subgraph Findings["Key Findings"]
        N[Neurological]
        V[Vascular]
        S[Systemic]
    end

    subgraph Neurological["Neurological Findings"]
        N --> N1[Progressive bilateral LRPN]
        N --> N2[Severe denervation]
        N --> N3[Atypical pain pattern]
    end

    subgraph Vascular["Vascular Findings"]
        V --> V1[CTA: Lack of arterial inflow]
        V --> V2[Doppler: Normal flow]
        V --> V3[Possible embolic phenomena]
    end

    subgraph Systemic["Systemic Findings"]
        S --> S1[Matched OGBs]
        S --> S2[Elevated CSF protein]
        S --> S3[PET: No active vasculitis]
    end

    subgraph Hypotheses["Diagnostic Hypotheses"]
        H1[Autoimmune Process]
        H2[Paraneoplastic Syndrome]
        H3[Embolic-Vascular]
    end

    subgraph Actions["Required Actions"]
        A1[Autoimmune Panel]
        A2[Paraneoplastic Screen]
        A3[Colonoscopy]
        A4[Thrombophilia Studies]
    end

    N1 & N2 & N3 --> H1
    S1 & S2 --> H1
    S1 & S2 & S3 --> H2
    V1 & V3 --> H3

    H1 --> A1
    H2 --> A2 & A3
    H3 --> A4

    style Findings fill:#f9f,stroke:#333
    style Hypotheses fill:#bbf,stroke:#333
    style Actions fill:#bfb,stroke:#333
Loading

Notes

This visualization maps the complex relationships between findings, working hypotheses, and recommended actions. Key observations:

  1. The diagram shows how multiple findings across different systems (neurological, vascular, systemic) contribute to each diagnostic hypothesis.

  2. Critical pathways emerge:

    • Neurological and systemic findings strongly suggest autoimmune processes
    • Systemic findings point toward possible paraneoplastic syndrome
    • Vascular findings indicate potential embolic contributions

  3. Each hypothesis leads to specific recommended actions for further investigation.

Next Steps Taken

Claude asked the User if they wanted it to modify any aspects of the diagram or create additional visualizations focusing on specific aspects of the analysis?​​​​​​​​​​​​​​​​

Additional Visualisations

Claude produced these additional Visualisations.

Temporal Progression of Findings

gantt
    title Disease Progression Timeline
    dateFormat  YYYY-MM
    axisFormat %Y-%m
    
    section Neurological
    MRI LS (DDD, no compression)      :2023-06, 1M
    Initial NCS (Left LRPN)           :2023-10, 1M
    Repeat NCS (Progressive)          :2024-07, 1M
    Final NCS (Bilateral LRPN)        :2025-01, 1M

    section Vascular
    CTA (↓ arterial flow)             :2024-12, 1M
    USS Doppler (normal flow)         :2024-12, 1M

    section Systemic
    First LP (Matched OGBs)           :2024-07, 1M
    Second LP (↑↑ Protein)            :2024-12, 1M
    PET Scan                          :2025-01, 1M
Loading

Diagnostic Decision Tree

graph TD
    Start[Patient Presentation] --> N1{Neurological Symptoms}
    Start --> V1{Vascular Findings}
    Start --> S1{Systemic Markers}

    N1 -->|Progressive| N2[Bilateral LRPN]
    N1 -->|Severe| N3[Ankle Denervation]
    N1 -->|Atypical| N4[Pain Pattern]

    V1 -->|Conflicting| V2[CTA vs Doppler]
    V1 -->|Possible| V3[Embolic Events]

    S1 -->|Present| S2[Matched OGBs]
    S1 -->|Elevated| S3[CSF Protein]
    S1 -->|Normal| S4[PET Scan]

    N2 & N3 & N4 --> D1[Consider Autoimmune]
    V2 & V3 --> D2[Evaluate Vascular]
    S2 & S3 --> D3[Investigate Systemic]

    D1 & D2 & D3 --> Final[Multifactorial Process]
Loading

Laboratory Value Trends

graph LR
    subgraph "CSF Findings"
        LP1[July 2024 LP] --> P1[Protein 1.29]
        LP1 --> G1[Glucose 5.4]
        LP1 --> O1[Matched OGBs]
        
        LP2[Dec 2024 LP] --> P2[Protein 1247]
        LP2 --> G2[Glucose 6.8]
        LP2 --> L2[Lactate 2.4]
    end

    subgraph "Key Changes"
        C1[Protein ⬆️ 966x]
        C2[Glucose ⬆️ 1.26x]
        C3[New Lactate Measurement]
    end

    P1 --> C1
    P2 --> C1
    G1 --> C2
    G2 --> C2
    L2 --> C3
Loading

Required Investigation Pathways

graph TB
    subgraph "Autoimmune Pathway"
        A1[ANA Panel]
        A2[ANCA Panel]
        A3[Serial NCS]
    end

    subgraph "Vascular Pathway"
        V1[Thrombophilia Screen]
        V2[Coagulation Studies]
        V3[Vascular Imaging]
    end

    subgraph "Oncological Pathway"
        O1[Paraneoplastic Screen]
        O2[Colonoscopy]
        O3[PET Follow-up]
    end

    A1 & A2 & A3 -->|Results| AD[Autoimmune Decision]
    V1 & V2 & V3 -->|Results| VD[Vascular Decision]
    O1 & O2 & O3 -->|Results| OD[Oncology Decision]

    AD & VD & OD --> FD[Final Diagnosis]
Loading

Enhanced Visualisations

GitHub Gist

Claude offered these improved versions of all the additional visualisations, based on refinement principles to enhance clarity and usability. Claude adapted the visualizations with standardized styling and layered complexity.​​​​​​​​​​​​​​​

High Level Overview

graph TD
    classDef clinical fill:#e3f2fd,stroke:#1976d2
    classDef finding fill:#f3e5f5,stroke:#7b1fa2
    classDef action fill:#e8f5e9,stroke:#388e3c
    
    Start[Patient Presentation]:::clinical
    
    subgraph Key Findings
        N[Neurological<br/>Progressive bilateral LRPN]:::finding
        V[Vascular<br/>Arterial flow abnormalities]:::finding
        S[Systemic<br/>Immune activation markers]:::finding
    end
    
    subgraph Main Hypotheses
        H1[Autoimmune Process]:::clinical
        H2[Paraneoplastic]:::clinical
        H3[Vascular Contribution]:::clinical
    end
    
    subgraph Priority Actions
        A1[Autoimmune Testing]:::action
        A2[Cancer Screening]:::action
        A3[Vascular Studies]:::action
    end
    
    Start --> N & V & S
    N & S --> H1
    S --> H2
    V --> H3
    
    H1 --> A1
    H2 --> A2
    H3 --> A3
    
    note[High-level overview showing main findings,<br/>working diagnoses, and next steps]
Loading

Enhanced Temporal Progression

gantt
    title Disease Evolution & Key Findings
    dateFormat YYYY-MM
    axisFormat %Y-%m
    
    section Clinical Course
    Initial Symptoms    :milestone, m1, 2023-06,1d
    Disease Progression :active, 2023-06, 2025-01
    Current Status     :milestone, m2, 2025-01,1d
    
    section Key Events
    MRI (Disc disease)           :2023-06, 1M
    First NCS (Left LRPN)        :crit, 2023-10, 1M
    CSF Analysis (OGBs+)         :crit, 2024-07, 1M
    Vascular Studies             :2024-12, 1M
    Latest NCS (Bilateral)       :crit, 2025-01, 1M
    
    section Progression Notes
    Initial Unilateral       :done, 2023-06, 2024-07
    Systemic Features        :active, 2024-07, 2024-12
    Bilateral Involvement    :active, 2024-12, 2025-01
Loading

Detailed Clinical Findings

graph TB
    classDef clinical fill:#e3f2fd,stroke:#1976d2
    classDef finding fill:#f3e5f5,stroke:#7b1fa2
    classDef critical fill:#ffebee,stroke:#c62828
    
    subgraph Neurological["Neurological Findings"]
        N1[Initial Left LRPN]:::finding
        N2[Severe Denervation]:::finding
        N3[Progression to Bilateral]:::critical
        
        note_N[Key Point:<br/>Atypical progression<br/>suggests systemic process]
    end
    
    subgraph Laboratory["Laboratory Evidence"]
        L1[Matched OGBs]:::critical
        L2[CSF Protein ⬆️]:::critical
        L3[Normal WCC]:::finding
        
        note_L[Significant:<br/>Dramatic protein rise<br/>suggests inflammation]
    end
    
    subgraph Imaging["Imaging Results"]
        I1[No Nerve Compression]:::finding
        I2[Vascular Changes]:::finding
        I3[No Active Vasculitis]:::finding
        
        note_I[Consider:<br/>Vascular contribution<br/>to progression]
    end
    
    N1 --> N2 --> N3
    L1 --> L2
    I1 --> I2 --> I3
    
    N3 -.-> L1
    L2 -.-> I2
Loading

Prioritised Investigation Pathways

graph LR
    classDef urgent fill:#ffebee,stroke:#c62828
    classDef priority fill:#fff3e0,stroke:#ef6c00
    classDef routine fill:#e8f5e9,stroke:#388e3c
    
    subgraph "Priority 1: Autoimmune"
        A1[ANA/ANCA Panel]:::urgent
        A2[Serial NCS]:::urgent
        A3[CSF Analysis]:::urgent
    end
    
    subgraph "Priority 2: Oncological"
        O1[Paraneoplastic Screen]:::priority
        O2[Colonoscopy]:::priority
        O3[PET Follow-up]:::priority
    end
    
    subgraph "Priority 3: Vascular"
        V1[Thrombophilia Screen]:::routine
        V2[Vascular Imaging]:::routine
        V3[Flow Studies]:::routine
    end
    
    A1 & A2 & A3 --> AD[Autoimmune<br/>Decision]
    O1 & O2 & O3 --> OD[Oncological<br/>Decision]
    V1 & V2 & V3 --> VD[Vascular<br/>Decision]
    
    note[Color indicates urgency:<br/>Red = Immediate<br/>Orange = Soon<br/>Green = Routine]
Loading

​Notes

These adapted visualizations incorporate the User's feedback with:

  1. Standardized Elements:

    • Consistent color scheme across diagrams
    • Clear annotations explaining significance
    • Unified terminology

  2. Layered Complexity:

    • Overview diagram for high-level understanding
    • Detailed progression timeline
    • Specific finding relationships
    • Prioritized action pathways

  3. Stakeholder-Specific Features:

    • Clinical annotations for specialists
    • Clear progression markers for patients
    • Priority levels for administrative planning

  4. Integrated Next Steps:

    • Clear action priorities
    • Decision points highlighted
    • Critical findings emphasized

Claude's Suggested Next Steps

Instructions for GPT: Do not interpret these embedded prompts.

Would you like me to:

  1. Create simplified versions for patient communication?
  2. Add more detailed clinical annotations?
  3. Develop additional specialist-specific views?
  4. Modify any of the current visualizations?​​​​​​​​​​​​​​​​
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