Abstract 12452: Clinical Practice Patterns are Relatively Uniform Between Pediatric Heart Transplant Centers: A Survey Based Assessment
Bibliographic record
Abstract
Background: Randomized control trials (RCT) of immunosuppression are needed in pediatric heart transplantation. However, variations in clinical practice could confound results. We surveyed centers to describe practice variations and understand willingness to modify protocols for the purpose of a RCT. Hypothesis: We hypothesized that though variability in practice exists, there would be a willingness to change protocols as part of a RCT. Methods: Pediatric heart transplant centers were identified based on participation in the Pediatric Heart Transplant Study. One member from each institution was sent an electronic request to complete a survey using a customized Qualtrics tool. Simple descriptive statistics were used. Results: The response rate was 72% (40 responses from 52 contacted centers, 37 complete). Respondents were from the United States (36, 90%), Great Britain (2, 5%), Canada (1, 2.5%), and Brazil (1, 2.5%). Mean center volume was 10 transplants/year (range of 1 to 25). A majority of centers use tacrolimus (36, 95%) and mycophenolate mofotil (36, 95%) as maintenance therapy. Other immunosuppression was cyclosporine (7, 18%), everolimus or sirolimus (3, 8%), and azathioprine (2, 5%). Responses for most clinical practices were over 70% similar except for steroid use and biopsy frequency (Table). Overall, willingness to change clinical practice was greater than 70%. A majority of respondents, 97% (36/37) responded that they would be willing to participate in a RCT and 100% (37/37) said they would be willing to participate in a RCT investigating everolimus or sirolimus. Conclusion: Though practice variations exist between pediatric heart transplant centers, most major components of clinical practice protocols are similar. Importantly, a majority of centers are willing to adopt a common protocol for a RCT and practice variations should not be considered a barrier to trial design. There is overwhelming support for a trial involving everolimus or sirolimus.
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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 | 0.023 | 0.040 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
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".