Bibliographic record
Abstract
Sir: I read with interest the report on antimicrobial therapy with hyperbaric oxygen treatment in the setting of necrotizing fasciitis by Anwar et al.1 Their case series comprised 28 patients admitted between 1997 and 2002. Anwar and colleagues write that there is a “lack of any worthwhile articles negating the benefits of hyperbaric oxygen therapy.…” My colleagues and I recently conducted a retrospective epidemiologic study of 216 patients hospitalized throughout Florida and discharged in 2001 with a principal discharge diagnosis of necrotizing fasciitis.2 We reported an unadjusted hospital mortality rate of 5.3 percent in patients who received hyperbaric oxygen therapy during their hospital stay and a hospital mortality rate of 11.7 percent in the patients who did not receive hyperbaric oxygen therapy (unadjusted relative risk of death for treated versus untreated patients, 0.45; p = 0.42). After controlling for age, sex, excisional debridement of the wound, diabetes, and three other demographic and clinical variables, hyperbaric oxygen treatment appeared to reduce the risk of hospital mortality by 52 percent; however, the result was not statistically significant (adjusted relative risk, 0.48; p = 0.39). The previous studies cited by Anwar et al. had sample sizes of 54 or fewer patients.1 Adjustment for confounders is difficult in small studies. The patients treated by Anwar and colleagues received clindamycin.1 Clindamycin has been shown to reduce the odds of hospital mortality by 89 percent among patients hospitalized with invasive group A streptococcal disease who have group A streptococcal necrotizing fasciitis (adjusted odds ratio, 0.11).3 This result was statistically significant (95 percent confidence interval, 0.01 to 0.89).3 Anwar et al. make a good point about the lack of randomized controlled trials evaluating the efficacy of hyperbaric oxygen therapy in the management of necrotizing fasciitis. Future observational studies in this area should be multicenter and prospective to minimize various epidemiologic biases and facilitate the control of several confounders. Zuber D. Mulla, Ph.D. Department of Obstetrics and Gynecology Paul L. Foster School of Medicine Texas Tech University Health Sciences Center 4800 Alberta Avenue El Paso, Texas 79905 [email protected]
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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 | 0.001 | 0.007 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.003 | 0.004 |
| Insufficient payload (model declined to judge) | 0.003 | 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".