Guidelines for nutrition therapy in critical illness: are not they all the same?
Bibliographic record
Abstract
In general, clinical guidelines identify, summarize, and evaluate the most current data concerning prevention, diagnosis, prognosis, therapy and cost for a specific patient population. This paper will briefly describe the authors' point of view regarding controversial aspects of adult critical care nutrition therapy guidelines published by preeminent professional societies in the United States (US), Canada, and Europe. The US guidelines were developed by subject matter experts to offer recommendations for specialized nutrition therapy that are supported by review and analysis of the pertinent current literature, other national and international guidelines, and by a blend of expert opinion and clinical practicality. A similar strategy was used to compile all three guideline publications resulting in many areas of common agreement, but disparate substantive recommendations do exist regarding: indirect calorimetry versus predictive equations, prokinetics in the intensive care unit (ICU), arginine use in the ICU, probiotic use in the ICU, and acceptable gastric residual volumes in the ICU patient. All of the guidelines are based on high quality studies in patients with critical illness, but like any other therapeutic modality for an ICU patient, nutritional interventions require a multidisciplinary approach that incorporates institutional best practices, individual patient considerations, and above all, clinical judgment.
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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 | 0.024 | 0.102 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.004 | 0.005 |
| Science and technology studies | 0.002 | 0.004 |
| Scholarly communication | 0.005 | 0.006 |
| Open science | 0.005 | 0.003 |
| Research integrity | 0.008 | 0.010 |
| Insufficient payload (model declined to judge) | 0.003 | 0.003 |
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".