Pediatric Pharmacokinetics of Vancomycin: A Canadian Perspective
Bibliographic record
Abstract
or cardiovascular death, so it would have been more appropriate to refer to a reduction in the incidence of myocardial infarction, as opposed to cardiovascular events.Our third issue of concern relates to the data for myocardial infarction, which was 1 of 3 outcomes measured in the study.The authors reported a 0.6% reduction in this outcome among patients assigned to receive double-dose clopidogrel, relative to those receiving the standard dose.There are 2 reasons why we question the clinical importance of this result.First, the effect size was small and of debatable clinical importance.Second, it is possible that this finding is a false positive (type 1 error), as no p value adjustment was made for the multiple comparisons performed in the trial.4 The authors also used a postrandomization subgroup of the overall trial population, which leads to additional risk of a type 1 error.5 Our fourth issue of concern is the lack of reporting of harm in the conclusion statements of the abstract and the full article, which might lead a reader to believe that there are no risks associated with the double-dose regimen.In fact, the incidence of major bleeding (as defined by the CURRENT-OASIS 7 authors) was higher in the double-dose group than the standard-dose group (1.6% versus 1.1%, hazard ratio 1.41, 95% confidence interval 1.09-1.83,p = 0.009). 2 This represents a 0.5% absolute increase in the hazard of harm (major bleeding).The omission of this information from the concluding statements appears to be selective reporting, which is misleading.Our final issue of concern relates to the overall assessment of harm versus benefit.Specifically, the 0.6% reduction in risk of myocardial infarction would seem to be nullified by the 0.5% increase in the risk of major bleeding.Although some would argue that the benefit of preventing myocardial infarction outweighs the risk of a major bleeding event, these 2 outcomes are only a subset of the possible effects of the double-dose regimen.Returning to our first issue of concern, described above, a full analysis of serious adverse events could help in determining the net effect of the double-dose regimen and provide more confidence in saying whether the benefit outweighs the risk.Does this study provide enough information to support a double-dose regimen of clopidogrel?We're not convinced.Does something need to be done about the selective reporting of harm in conclusion statements?Absolutely.
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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 | 0.003 | 0.006 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.003 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.006 |
| Insufficient payload (model declined to judge) | 0.007 | 0.001 |
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".