Diagnosis, Evaluation, and Management of the Hypertensive Disorders of Pregnancy: Executive Summary
Bibliographic record
Abstract
In this comprehensive new SOGC Guideline1.Magee L.A. Pels A. Helewa M. Rey E. von Dadelszen P. SOGC Hypertension Guideline Committee Diagnosis, evaluation, and management of the hypertensive disorders of pregnancy: executive summary. SOGC Clinical Practice Guideline No. 307, May 2014.J Obstet Gynaecol Can. 2014; 36: 416-438Abstract Full Text Full Text PDF PubMed Scopus (342) Google Scholar I was surprised to see that methyldopa and (to some extent) clonidine are recommended as “alternative” oral therapeutic agents for the treatment of severe hypertension. While the immediate-release nifedipine capsule has an onset of action approximately 20 minutes after administration and oral labetalol 20 minutes to two hours (peak effect 1 to 4 hours), the onset of action of oral methyldopa is four to six hours and immediate-release clonidine 30 minutes to one hour (peak effect 2 to 4 hours).2.Drug Information (Lexicomp). UpToDate. Waltham, MA. Available at: http://www.uptodate.com/home/drugs-drug-interaction. Accessed May 6, 2014.Google Scholar While this is the executive summary (23 pages!) and it does not contain discussion on treatment, it is widely recognized that severe hypertension (defined in this guideline as a systolic blood pressure>160 mmHg or a diastolic pressure>110 mmHg) is associated with an increased risk of severe morbidity and mortality and should be controlled rapidly. Given this, I question the wisdom of “recommending” treatment that may take up to six hours to have a clinical effect. I trust that the diagnostic criteria for severe hypertension will be more fully discussed in the main document, since at least one well-quoted case series reports four of 24 peripartum strokes occurring with maternal systolic blood pressures of between 155 and 160 mmHg.3.Martin Jr., J.N. Thigpen B.D. Moore R.C. Rose C.H. Cushman J. May W. Stroke and severe preeclampsia and eclampsia: a paradigm shift focusing on systolic blood pressure.Obstet Gynecol. 2005; 105: 246Crossref PubMed Scopus (361) Google Scholar Finally, I would like to suggest that in this electronic age future SOGC guidelines be circulated to the membership in draft form, so that all interested parties have a chance to review and comment before formal publication.
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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 | 0.005 | 0.015 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.004 | 0.004 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.004 |
| Insufficient payload (model declined to judge) | 0.019 | 0.025 |
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".