Bibliographic record
Abstract
The physician-led “Choosing Wisely” campaign of the American Board of Internal Medicine Foundation, which has huge potential to improve health care quality while lowering costs, received another important boost with the American Society of Hematology's list of five hematology tests, treatments, and procedures that are common—and frequently not appropriate.FigureASH's “Top 5” list is as follows: Limit surveillance computed tomography scans in asymptomatic patients following curative-intent treatment for aggressive lymphoma. Don't use inferior vena cava filters routinely in patients with acute venous thromboembolism (VTE). Do not transfuse more than the minimum number of red blood cell units necessary to relieve symptoms of anemia or to return a patient to a safe hemoglobin range (7 to 8 g/dL in stable, non-cardiac, inpatients). Do not test for thrombophilia in adult patients with VTE occurring in the setting of major transient risk factors (surgery, trauma or prolonged immobility). Do not administer plasma or prothrombin complex concentrates for non-emergent reversal of vitamin K antagonists (i.e. outside of the setting of major bleeding, intracranial hemorrhage or anticipated emergent surgery). A manuscript detailing the recommendations is now online ahead of print in Blood (doi: 10.1182/blood-2013-07-518423). In publishing its list, ASH joins ASCO, ASTRO, the American College of Surgeons, the Commission on Cancer, and many other medical societies that are encouraging their members to “choose wisely” when they prescribe tests and treatments. “Hematology is a specialty with many new and increasingly expensive tests and treatments,” the Chair of the ASH Choosing Wisely Task Force, Lisa Hicks, MD, of St. Michael's Hospital and the University of Toronto, said in a news release. “While these new diagnostic and treatment strategies represent important advances, there is also potential to pose significant harm and cost to patients if over- or mis-used. “The ASH Choosing Wisely list serves as a reminder to hematologists to take a step back and question whether certain routinely used procedures are really necessary, and to gradually change their practices to maximize the value of care.” The guiding principles of the Choosing Wisely campaign are evidence, cost, frequency, and scope of practice, but ASH chose to add another criterion: the concept of avoiding harm. Thus, the news release notes, tests, procedures or treatments that are likely to increase the risk of harm were prioritized during ASH's selection process.
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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 | 0.005 | 0.013 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.004 | 0.001 |
| Scholarly communication | 0.008 | 0.003 |
| Open science | 0.001 | 0.004 |
| Research integrity | 0.011 | 0.010 |
| Insufficient payload (model declined to judge) | 0.315 | 0.183 |
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".