Bibliographic record
Abstract
Sir: We thank Dr. Wheble and colleagues for their interest in our study regarding the use of transversus abdominis plane blocks with bupivacaine following microsurgical abdominal tissue breast reconstruction. Dr. Wheble and colleagues present their results from a retrospective, nonrandomized, observational study that evaluated the use of a single ultrasound-guided transversus abdominis plane block (n = 12) compared with a historic cohort (n = 15).1 They found using this technique that there was a significantly lower morphine requirement in the transversus abdominis plane block group, a significant reduction in hospital stay, and fewer episodes of postoperative nausea and vomiting. As a result, they suggested that, for pain control, the use of a single dose of ultrasound-guided transversus abdominis plane block may be as effective and more cost-effective and have fewer potential complications. To address the issue of safety, inserting a soft-tipped epidural catheter into the triangle of Petit under direct vision was a completely safe procedure and we did not have any transversus abdominis plane block–related complications in our study.2 In many ways, for a surgeon, directly visualizing the layers of the abdominal wall is a safer technique than using an ultrasound-guided technique. As in the study design by Dr. Wheble and colleagues,1 we previously performed a study to compare a group of patients who received transversus abdominis plane block with a historic control group who did not, and found an impressively significant reduction in morphine consumption in the transversus abdominis plane block group by approximately 75 percent.3 However, it is important to note that effects of the intervention tend to be more pronounced in observational studies compared with randomized controlled trials when both known and unknown confounders are balanced between the two groups through randomization. Therefore, to definitively determine whether a single dose of ultrasound-guided transversus abdominis plane block is more effective, a double-blind, randomized, controlled trial study design should be used to test this hypothesis. The issue of the cost effectiveness of a single dose versus multiple intermittent boluses of bupivacaine for pain control is an important and pertinent issue that has not been investigated and requires further investigation. DISCLOSURE The authors have no financial interest to declare in relation to the content of this communication. Toni Zhong, M.D., M.H.S. University Health Network Breast Restoration Program Division of Plastic and Reconstructive Surgery University Health Network Christine B. Novak, P.T., Ph.D. Department of Surgery Division of Plastic Reconstructive Surgery Toronto Western Hospital Hand Program Stefan O. P. Hofer, M.D., Ph.D. Division of Plastic Surgery Department of Surgery and Department of Surgical Oncology University Health Network Toronto, Ontario, Canada
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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 | 0.002 | 0.035 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.002 |
| Scholarly communication | 0.003 | 0.004 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.013 | 0.020 |
| Insufficient payload (model declined to judge) | 0.033 | 0.025 |
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".