The Effect of Level I Evidence on Surgical Decision Making in the United States Versus Canada
Bibliographic record
Abstract
BACKGROUND: In this study, we examined the difference that randomized trials favoring either surgery or nonsurgical treatment had on the surgical indications of American versus Canadian surgeons. METHODS: One randomized trial favoring surgical management of clavicle fractures and another one favoring nonsurgical management of Achilles tendon ruptures were used. American and Canadian orthopaedic surgeons were surveyed regarding their surgical indications for these injuries. RESULTS: More than 2000 US and 200 Canadian responses were received. For clavicles, 57% of US respondents indicated that the trial changed their practice, with 64% operating on more fractures, compared with Canadians at 78% and 68%, respectively. For Achilles, 37% of US respondents indicated that the trial changed their practice, with 29% operating on fewer ruptures, compared with Canadians at 72% and 67%, respectively. CONCLUSION: American surgeons seem more willing to alter their practice to "evidence-based" indications for a trial that favors surgery rather than one that does not.
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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 | 0.076 | 0.420 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.003 | 0.004 |
| Bibliometrics | 0.006 | 0.008 |
| Science and technology studies | 0.002 | 0.004 |
| Scholarly communication | 0.007 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.007 | 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 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".