Salty broth for salicylate poisoning? Adequacy of overdose management advice in the 2001 Compendium of Pharmaceuticals and Specialties.
Notice bibliographique
Résumé
BACKGROUND: The Compendium of Pharmaceuticals and Specialties (CPS) is a collection of monographs written by pharmaceutical companies and published by the Canadian Pharmacists Association. The CPS is widely available and is consulted frequently by Canadian physicians. We examined overdose management advice contained in the CPS to see whether it reflects current standards. METHODS: We restricted our review to 10 classes of medication for which an overdose is frequently fatal: acetaminophen, beta-blockers, calcium-channel blockers, digoxin, lithium, opioids, salicylates, tricyclic antidepressants, theophylline and valproic acid. A panel of 3 toxicologists arrived at a consensus on indicated, contraindicated and futile interventions for each of these classes of drug. Monographs were then rated for their inclusion of essential interventions as excellent (listed all interventions and unique supportive care issues and gave correct and complete indications), good (listed the key interventions and gave correct and complete indications), fair (listed the key indications but failed to give proper indications) or poor (failed to list the key interventions). Monographs were also rated on how well they warned against contraindicated interventions as excellent (did not advocate any futile or contraindicated treatments and warned against contraindicated treatments), good (did not advocate any futile or contraindicated treatments), fair (did not advocate any contraindicated treatments but did list some simple futile treatments) or poor (advocated contraindicated or complicated futile treatments, such as unnecessary hemodialysis). We also considered whether the monograph would allow a clinician to manage an overdose, whether it served to refresh one's memory and whether it was simply misleading or dangerous. RESULTS: We reviewed 119 monographs, of which 25 (21%) were adequate to allow a clinician to manage an overdose. Another 25 monographs were not adequate to allow a clinician to manage an overdose but would serve to refresh the memory regarding key management points. Sixty monographs (50%) contained misleading or dangerous advice. Nine monographs (8%) did not fall into any of these categories. In terms of listing essential interventions, 61 monographs (51%) were poor, 35 (29%) were fair, 22 (18%) were good, and 1 (1%) was excellent. For warning against contraindicated interventions, 57 monographs (48%) were poor, 9 (8%) were fair, 51 (43%) were good, and 2 (2%) were excellent. INTERPRETATION: Overdose management advice in the CPS is inadequate in most cases and is misleading or dangerous in half of the monographs examined. These sections should be omitted or rewritten to reflect current standards of care. Physicians should refer to authoritative sources (e.g., current toxicology texts, computerized databases or local poison control centres) for poisoning management advice.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,009 | 0,053 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,004 | 0,005 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».