Why this work is in the frame
A frame that forgets how it found something cannot be audited. These are the routes that admitted this work.
Bibliographic record
Abstract
Q: Is any evidence available to support practices for verifying nasogastric tube (NGT) placement in critically ill pediatric patients?A: Beth Lyman, RN, MSN, CNSC, replies: Yes, there is evidence to guide this practice; there is even an international work group addressing this issue.The American Society for Parenteral and Enteral Nutrition has a task force called the NOVEL (New Opportunities for Verification of Enteral tube Location) project. This group of physicians and nurses from Australia, Canada, and the United States is working to promote best practice for verification of NGT placement.Twenty-four percent of hospitalized pediatric patients require an NGT. Of those patients, approximately 18% are in a pediatric intensive care unit.1 A 1999 pediatric study by Ellett and Beckstrand2 documented that 22% to 44% of NGTs were misplaced when verified by abdominal radiography. A study by Quandt et al3 documented that the odds of an NGT being in the distal esophagus are 2.74 times higher if a neonate is intubated.A patient safety alert issued in 2012 recommended immediate discontinuation of the use of auscultation to verify correct NGT placement.4 Despite this recommendation, a study published by Metheny and colleagues5 in 2012 documented continued use of this method. The Lyman study conducted in 2015 asked the 63 participating centers to share their primary and secondary method(s) to verify NGT placement, with responses of aspiration (n = 21), auscultation (n = 18), measurement (n = 8), pH (n = 10), and radiography (n = 6).1Although the gold-standard method for verification of NGT placement for adult patients is considered an abdominal radiograph, pediatric clinicians have been reluctant to embrace this practice because of concerns over the long-term cumulative effects of radiation exposure. In addition to the concerns about radiation exposure, there is growing evidence that radiographs can be interpreted incorrectly.6,7 A 2011 study looked at 4330 pH aspirates from NGTs along with 635 pH aspirates from pediatric intensive care unit patients with an endotracheal tube.8 In this population, 27% of the patients received an acid-suppressing medication, resulting in an average pH of 4.2, compared with 3.4 from those patients who did not receive any of these medications.Investigators also found nurses were not able to discern gastric from pulmonary secretions upon visual inspection. Gilbertson et al8 concluded that a pH of 5 or less predicted gastric placement 90% of the time. The average pH for aspirates from the endotracheal tube was 8.3 (95% CI, 6–9.5). A pH of 5 to 5.5 or less is what is used in Canada, Australia, and the United Kingdom as a means of verifying NGT placement. The pH measurement is to be done at the bedside even when an abdominal radiograph or other device, such as an electromagnetic device, is used.9Accurate measurement of how far to insert an NGT is associated with better outcomes. The previously mentioned patient safety alert recommended use of NEMU (nose-earlobe-midumbilicus, or the midpoint between the xiphoid process and umbilicus). Previous studies have documented that use of the NEX (nose-earlobe-xiphoid) method can result in the NGT being in the distal esophagus.10The use of an electromagnetic device to place an NGT or postpyloric feeding tube has been studied repeatedly in critically ill adults and the pediatric population, with mixed results due to the potential for misinterpretation of the screen and time needed to place the tubes.11–14 The National Patient Safety Agency’s (United Kingdom) recommendation to obtain an abdominal radiograph or pH in conjunction with such a device is echoed by others in the United States who have studied this device in adult patients.15,16 The recommendation to check an abdominal radiograph or pH, even when an electromagnetic device is used, should pertain to children as well.When placing an NGT, consider the following approach:
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.014 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.000 | 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 it