Notice bibliographique
Résumé
ProfessorDepartment of AnaesthesiaUniversity of TorontoSunnybrook and Women’s College Health Sciences Centre Toronto, OntarioGerald.Edelist@sunnybrook.on.caTo the Editor:—The article by Williams-Russo et al. 1and the editorial by Raja and Haythornthwaite 2imply that hypotensive anesthesia for total hip replacement (THR) is safe in terms of long-term cognitive impairment. The editorial states that, “the lack of any short or long-term cognitive impairment in the study by Williams-Russo et al. with the use of hypotensive epidural anesthesia is encouraging,” and that, “no declines in cognitive function were found in an elderly nonrisk population.” In the Discussion, Williams-Russo et al. state that, “Complication rates after elective THR observed in the study of high-risk patients are similar to or lower than those of previous studies of elective hip and knee replacement in unselected patients receiving normotensive anesthesia.”Unfortunately, this statement does not translate to the lack of any short-term or long-term cognitive impairment. Williams-Russo et al. cite their own previous work with bilateral total knee replacement that used the same battery of neuropsychological tests. 3The 1995 study showed that 5% of patients had “clinically significant cognitive impairment” at 6 months. In the Results, the authors included not only baseline, 1-week, and 6-months scores for each test, but also include the percentage of patients with a decline in score from the baseline that is worse than the minimally clinical important difference for that test, a difference that they had defined. This was most helpful when interpreting the data because the standard deviations of the means for the tests were very large. This clinical importance difference data were not included in their most-recent study in which, once again, the standard deviations are large in relation to the means, which make comparison extremely difficult. I would be interested in seeing this data (if available) and to know what percentage of patients in the hypotensive groups had clinically important cognitive impairment according to their previous definition, to compare this number with the 1995 incidence of 5%. Is this impairment similar or is it lower? Do the authors think that these patients did better than the patients in their previous study? If so, could they please comment on why this should be so?The conclusion of Williams-Russo et al. that there was no difference in early and late-term cognitive, cardiac, and renal complications in elderly patients between the two hypotensive groups for THR seems appropriate, given the data that were presented. As for the safety of total joint replacement in terms of long-term cognitive impairment, as implied by Raja and Haythornthwaite’s editorial, a 5% incidence of this complication is hardly encouraging, regardless of whether the anesthetic is normotensive or hypotensive. If this incidence is lower with hypotensive anesthesia, this observation certainly deserves an explanation.
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 distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,002 | 0,001 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,002 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,007 | 0,006 |
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; les deux têtes enseignantes s’accordent sur ce qui est montré ici.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».