Prebiologic Evaluation: Follow-up Survey of Practice Patterns in Nova Scotia
Notice bibliographique
Résumé
Introduction: There has been a significant increase in the use of biologic therapy across Canada. Given the risks associated with this therapy, appropriate pre-treatment evaluation is important. This study reports the impact a pre-biologic therapy initiation checklist that was distributed across Nova Scotia with the goal of enhancing and streamlining care for patients receiving TNF-alpha inhibitor therapy. Changes in practice were examined using pre- and post-checklist distribution surveys. Methods: A pre-checklist survey was carried out in July 2012. The checklist was then distributed in February 2013 with a post-checklist survey conducted in July 2014. A total 63 specialists were provided with the checklist and invited to participate in the surveys. Results: Of the 63 surveys distributed, 35 (55.5%) were returned in both the pre- and post-surveys. The number of responding specialists was different with dermatology (8 vs. 6), rheumatology (9 vs. 5), and gastroenterology (18 vs. 24). In the post-survey the percentage reporting evaluation of risk activity/symptoms was high [HIV (88%), chronic infection (97%), herpes simplex (62%), perianal sepsis (69%) and cervical dysplasia in women (52%)]. The reported testing was also high [CBC (100%), LFT (97%), TB Skin Test (100%), CXR (89%), creatinine (89%), CRP (94%), and HBV (94%)]. Less frequent testing included ESR (63%), HIV (65%), varicella antibodies (64%), and urinalysis (21%). Vaccinations that were considered important included HPV (30%), HBV (61%), Tetanus (41%), Rubella (47%), Pneumococcal (71%) and Seasonal Influenza (73%). Specialists were less likely to provide vaccinations (37%) and most referred the patients to their primary care physician (97%). Routine warnings to patients were universal for infection (100%), but less for allergic/infusion reactions (71%) and cancer (63%). Figure 1 shows that several practices increased between the pre and post survey. These included HIV serology (p=0.017), Hepatitis B serology (p=0.021), arranging vaccinations (p=0.044), and referral to family physician for vaccinations (p=0.033). Varicella zoster serology was found to have decreased (p=0.016). Many of the other activities increased but not significantly.Figure 1Conclusion: The ‘Biologic Checklist' appears to increase the pre-treatment evaluation and vaccination rate in patients receiving biologic therapy.
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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 | 0,006 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,001 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 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 tête enseignante, 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 ».