Notice bibliographique
Résumé
We thank the author for his comments [1]. It is clear that preoperative atrial fibrillation (AF) has different implications among patients with valve disease and those requiring isolated coronary artery bypass graft surgery (CABG). However, patients with coronary artery disease also share important risk factors with patients with some of the more common valve pathologies, such as senescent calcific aortic stenosis and ischaemic mitral regurgitation. Furthermore, in our study, only 11% of the entire study cohort was isolated valve patients. Therefore, the study’s findings are largely driven by the CABG patients, and the small proportion of isolated valve patients was not expected to introduce unacceptable heterogeneity within the study population nor appreciably change the study’s findings. To check this, we performed subgroup analysis among the CABG and valve patients separately and did not find substantive effect modification. Furthermore, as pointed out by the author, the retrospective nature of the study did not allow us to precisely classify patients according to the currently accepted definitions of paroxysmal, persistent and permanent AF [2]. However, in everyday clinical practice, it is often difficult to get a clear sense of the duration of AF and to reliably classify the patient presenting for cardiac surgery in AF without a previous history of the dysrrthythmia, and we do not feel that the lack of classification necessarily discredits our findings. Given that all of the patients with AF examined in this study had to have AF on preoperative electrocardiogram or a history of treatment for AF documented in the medical record, we probably have a larger proportion of persistent and permanent AF patients represented in this study, and our results must be interpreted with this in mind. Finally, a point was made about the low utilisation of oral anticoagulation as a potential mechanism for the adverse effect of AF on cardiac surgery outcomes. We did not have data on long-term use of medical therapies postoperatively including oral anticoagulants. The paper quoted in the discussion [3] was a population-based assessment (i.e., largely non-surgical patients) of warfarin use in the province where our centre is located, and appropriate treatment with warfarin compared favourably with contemporary literature. As a surrogate for warfarin use, we looked at the death and re-hospitalisation rates of AF patients with mechanical valves and found these to be significantly higher compared with those patients without AF (hazard ratio = 1.57, p = 0.01), suggesting that the negative effects of AF are not entirely obviated by and perhaps independent of the anticoagulation received for the mechanical prosthesis. Bando et al. [4] found similar results in a cohort of fully anticoagulated mechanical valve recipients with AF; however, this hypothesis remains to be evaluated in a future study. A particular strength of our study is the use of administrative re-hospitalisation data to determine outcomes in a large contemporary cohort of cardiac surgical patients. This eliminates the need to rely on patient self-report [5], a methodology we believe makes the telling of a good story far less compelling!
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 | 0,100 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,002 | 0,002 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,005 | 0,005 |
| Communication savante | 0,006 | 0,008 |
| Science ouverte | 0,004 | 0,005 |
| Intégrité de la recherche | 0,035 | 0,052 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,018 | 0,014 |
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 ».