Surgical epidemiology: a call for action
Bibliographic record
Abstract
Background Surgical approaches are receiving increasing attention as way to solve many global public health problems. The publication of Disease Control Priorities monograph initiated discussions of cost-effectiveness of surgical interventions in developing countries, (1) and many more recent publications have built upon its concepts. (2) Surgery can play vital role in helping countries meet their Millennium Development Goals 4, 5 and 6. (3) To build stronger case for surgery as part of armamentarium of cost-effective interventions in developing countries, epidemiologists need to work alongside their surgical colleagues to develop nascent field of surgical epidemiology. What is surgical epidemiology? Unfortunately, there is not yet an agreed definition for this field. This may reflect emerging nature of field, or lack of clarity and consensus about its goals and objectives. A useful starting point is definition of epidemiology as the study of distribution and determinants of health related or in specified populations and application of this study to control of health problems (4) An analysis of this definition in terms of its applicability to surgery suggests that clarity is needed in three components: (i) distribution and determinants of or events, (ii) populations involved, and (iii) its application to efforts to treat health problems. We focus on developing countries because we feel that discussions about role and cost-effectiveness of surgery in therapeutic armamentarium are most active in this setting. In addition, definitional issues and challenges are greater in developing countries, where we wish to encourage debate on surgical epidemiology. Definitions What are health-related or that we wish to study? Are they states such as obstructed labour? Or are they events such as surgical intervention? From surgical perspective an event often occurs after state, so one could argue that we need to study both. In addition, can also include sequelae and complications of surgery, such as nosocomial infections. (5) It is evident that refers to surgical condition. But what exactly is surgical condition? The Disease Control Priorities monograph defined this as any condition that requires suture, incision, excision, manipulation, or other invasive procedure that usually, but not always, requires local, regional, or general anaesthesia. (1) This definition avoids challenge of defining who is performing sutures, incisions, etc. and may thus include surgical procedures done by nurses, paramedical staff and general practitioners in addition to surgeons. Another definition of surgical condition is any condition for which most treatment is an intervention that requires suture, incision, excision, manipulation, or other invasive procedure that usually, but not always, requires anaesthesia (6) This definition raises more questions than answers. What exactly does potentially effective mean? Does this criterion vary depending on clinical or geographic contexts? Yet another definition from recent publication is that surgical condition is a disease state requiring expertise of surgically trained provider. (7) Here, we are left wondering about precise nature of expertise and surgical training required. In addition, we need to consider conditions for which only minority of patients need surgery. For example, only one out of six persons with severe head injury needs neurosurgical operation. However, ability to rapidly diagnose patients who need surgery along with availability of qualified provider and facilities to safely perform procedure are critical to lowering overall mortality from severe head injuries. Similar considerations apply to availability of Caesarean delivery to treat obstetrical complications. …
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
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 teacher head, 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".