Efficacy and compliance of small-bore chest tube insertion and pleurodesis protocols for the treatment of malignant pleural effusions
Bibliographic record
Abstract
19575 Background: Small-bore chest tubes are now recognized as a safe and effective alternative to large-bore catheter chest tubes for the treatment of malignant pleural effusions (MPEs). The Ottawa Hospital (TOH) developed protocols for insertion and pleurodesis to maximize efficiency and minimize complications. Objective: To evaluate the efficacy and compliance of small-bore chest tube insertion and pleurodesis protocols for the treatment of MPEs. Methods: Retrospective chart review of TOH medical oncology inpatients treated for a MPE using our small-bore chest tube insertion and pleurodesis protocols from February 2003 to May 2004. Outcomes reviewed included deviations from protocol (major and minor), proportion of patients proceeding to pleurodesis and efficacy at six weeks, complications, as well as length of hospital stay. Results: One-hundred and fourteen potential cases were identified, of those 78 small-bore chest tubes were inserted into 72 patients. Major deviations from the chest tube protocol occurred in 21 patients (27%) who lacked microbiological analysis of their pleural fluid. Major complications of tube insertion occurred in ten patients (13%) who developed pulmonary infections and two patients (2.5%) who developed a significant pneumothorax. Of the 78 tube insertions, 24 cases went on to pleurodesis. Major deviations from our pleurodesis protocol occurred in five patients (2.1%) who failed to have a chest xray twenty-four hours prior to pleurodesis. The most common complication post pleurodesis was pain with seven of 24 patients (29%) rating their pain as severe. Fifteen of the 24 patients (63%) had fluid reaccumulation within six-weeks post pleurodesis. Median length of stay for patients without pleurodesis versus those with pleurodesis was 14.5 and 16.0 days, respectively. Conclusions: Our preliminary data suggests that chest tube insertion and pleurodesis protocols have good compliance rates with low rates of complications. Only a minority of patients were able to proceed to pleurodesis and long term control of effusion occurs in less than half of patients in this subgroup. As well, pain control at the time of pleurodesis was not adequate in one third of patients with the current protocol. No significant financial relationships to disclose.
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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 | 0.011 | 0.054 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 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 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".