[The Canadian Society of Nephrology 2014 clinical practice guideline for timing the initiation of chronic dialysis: a paradigm shift and the return of the clinical nephrologist].
Bibliographic record
Abstract
The recent guideline of the Canadian Society of Nephrology for timing the initiation of chronic dialysis may be seen as a "paradigm shift", meaning, according to the Kuhns theory, the development of a different viewpoint. The guideline is based on a careful review of the literature, with primary emphasis on patient survival and quality of life. Hence, the Authors choose qualitative keywords (intention -to-defer, in place of the intention-to-start-early), but also a qualitative process for deciding the start of dialysis, by providing an intentionally concise list of signs and symptoms not reducible to numbers, such as the presence of uremic symptoms. The recent guideline of the Canadian Society of Nephrology, regarding the timing of the initiation of chronic dialysis, may be seen as a "paradigm shift", that means, according to Kuhns theory, the development of a different viewpoint. The guideline is based on a careful review of the literature, with primary emphasis on patient survival and quality of life. Hence, the Authors choose not only qualitative keywords (intention -to-defer, in place of intention-to-start-early), but also a qualitative process for deciding the start of dialysis, by providing an intentionally concise list of signs and symptoms not reducible to numbers, such as the presence of uremic symptoms. The clinical Nephrologist emerges victorious; the decision to initiate dialysis is in his-her hands; it is not a team-work, or a numeric algorhythm: its a clinical choice. The clinical judgment is the only guide above 6 mL/min of eGFR. Below this limit, dialysis has to be started; however, the Authors state that the optimal management of patients with an eGFR of 6 mL/min per 1.73 m2 or less, it is based on limited data. Hence, numbers are back to haunt us; nevertheless, we should take the best of this paradigm shift: the decision is again in our hands, the clinic is our weapon, the responsibility is not reducible to pretty formulae. If we cannot hide behind a computer screen, we have good reasons to exist, and we are alive.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.022 | 0.077 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.004 |
| Bibliometrics | 0.006 | 0.009 |
| Science and technology studies | 0.004 | 0.005 |
| Scholarly communication | 0.006 | 0.005 |
| Open science | 0.007 | 0.004 |
| Research integrity | 0.014 | 0.017 |
| Insufficient payload (model declined to judge) | 0.008 | 0.007 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".