Acute hepatitis after starting zinc therapy in a patient with presymptomatic Wilson’s disease
Notice bibliographique
Résumé
To the Editor: I read with great interest and more than a little dismay the article by Myers, Gregor, and Marotta 1 on the cost-effectiveness of hepatitis A vaccination in patients with chronic hepatitis C. While I found the article to be very well written and thorough, I find the premise for the article to be totally unacceptable.Are we to withhold a simple vaccination from our patients, knowing that they run the risk of severe morbidity or death simply because it may not be "cost effective" in a population study?This article calls to mind a story that was recently played out in the courts in the United States.There was once a large automobile manufacturer that produced a vehicle it knew was unsafe.Not only did they know that it was unsafe, they also knew how to fix the problem to render the vehicle safe.However, rather than do the right thing and fix the vehicle (at a cost of $11 per vehicle), they embarked on a course similar to Myers et al.They first calculated the cost of correcting the defect and then compared it with the cost they may incur if the defect was not corrected.They used data from the federal government and that the National Highway Traffic Safety Administration made available to them.They calculated the average damage per person killed by their vehicle.They added medical costs, property damage, insurance administration, legal and court costs, employer losses, victim pain and suffering, and funeral bills as well as "other costs."When they found that this cost would be less than the cost of correcting the defect on the vehicle, they elected to take their chances in court.Their strategy ultimately landed them in court and resulted in one of the largest settlements in the American legal system.The ethics involved in their decision-making process was headline news throughout the nation.The parallels between this story and the conclusions drawn from this article I find to be quite remarkable.I can see myself in the future consoling Mrs. X upon the death of her husband from hepatitis A superimposed on hepatitis C, a disease that could have been prevented by a simple vaccination, by handing her the article and saying, "but as you can see here, clearly it would not have been cost effective for me to have given your husband a simple vaccine."I was surprised that this article did not provoke more editorial comments from the editors of HEPATOLOGY and I certainly hope that the ACIP does not reconsider its stance on vaccinating all patients with hepatitis C with the hepatitis A vaccine.
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 | 0,001 | 0,012 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,002 | 0,001 |
| Communication savante | 0,001 | 0,002 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,013 | 0,009 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,001 |
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 ».