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Record W2913692963 · doi:10.1136/heartjnl-2018-314526

Creating order out of chaos: quality of care in heart failure

2019· letter· en· W2913692963 on OpenAlexaff
Justin A. Ezekowitz

Bibliographic record

VenueHeart · 2019
Typeletter
Languageen
FieldMedicine
TopicHeart Failure Treatment and Management
Canadian institutionsCanadian VIGOUR CentreUniversity of Alberta
Fundersnot available
KeywordsMedicineHeart failureQuality (philosophy)CHAOS (operating system)Order (exchange)Intensive care medicineMedical emergencyCardiologyComputer security

Abstract

fetched live from OpenAlex

Heart failure, once lacking in therapies, now has a rich and growing armamentarium that is available to reduce the morbidity and mortality and improve the quality of life for patients. But are we delivering this to patients and what is the evidence (beyond the randomised controlled trials (RCTs) of individual therapies) that we should do so in a systematic and auditable way via quality improvement initiatives? Analyses from England show an association of six hospital-based process measures to that of lower heart failure (HF) readmission rates (but not all-cause hospitalisations).1 Indeed, caution should be exercised as when focus is placed on one disease, and there may be missed opportunities on treating other diseases.2 Notably, individual measures were only modestly linked to better outcomes and the durability of this effect waned over the year as patients spent more time out of hospital than in. But is association causation? To this end, Agarwal and colleagues3 provide insight into this via a systematic review of RCTs that tested the efficacy of hospital-based improvements initiatives.4 They identified 14 RCTs across five countries—all high-income countries (HIC)—that employed a variety of techniques to improve the care of patients with HF. Of interest, two very large RCTs dominated the area and the heterogeneity (both clinical and statistical) limited the ability to numerically combine the results. The authors identified three key findings emanating from this body of work. First, there was substantial heterogeneity in the existing trials and datasets, and therefore this went from a meta-analysis to a narrative review. Second, baseline care of patients (in …

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.

How this classification was reachedexpand

Full frame distilled prediction

Teacher imitation

Not 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.

metaresearch head score (Codex)0.000
metaresearch head score (Gemma)0.000
Version: codex-gemma-dda1882f352aValidation status: machine_predicted_unvalidated
Candidate categoriesMeta-epidemiology (narrow)
Consensus categoriesnone
DomainCandidate signal: none · Consensus signal: none
Study designCandidate signal: Not applicable · Consensus signal: Not applicable
GenreCandidate signal: Commentary · Consensus signal: Commentary
Teacher disagreement score0.249
Threshold uncertainty score1.000

Codex and Gemma teacher scores by category

CategoryCodexGemma
Metaresearch0.0000.000
Meta-epidemiology (narrow)0.0000.000
Meta-epidemiology (broad)0.0010.000
Bibliometrics0.0000.000
Science and technology studies0.0000.000
Scholarly communication0.0000.000
Open science0.0000.000
Research integrity0.0010.001
Insufficient payload (model declined to judge)0.0000.000

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.

Opus teacher head0.033
GPT teacher head0.329
Teacher spread0.296 · how far apart the two teachers sit on this one work
Validation statusscore_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it

Classification

machine, unvalidated

Machine predicted; a candidate call from one teacher head, not a consensus.

Study designNot applicable
Domainnot available
GenreCommentary

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".

Quick stats

Citations2
Published2019
Admission routes1
Has abstractyes

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