140 Therapeutic Hypothermia – The quest for efficiency
Bibliographic record
Abstract
Hypoxic-ischemic encephalopathy (HIE) from perinatal asphyxia/birth depression occurs in 1 to 2 per 1000 live births. Therapeutic Hypothermia (TH) is the standard of care for newborns experiencing HIE. In 2015, we identified important delays in both the initiation and achievement of target temperature in patients referred to our Transport team (TT) for TH. In an effort to improve our practice and address the delays identified we undertook a number of practice change initiatives and outreach education measures. Our aim was to safely and efficiently increase the number of outborn infants reaching target temperature within the 6 hour TH target post referral. Retrospective cohort study of all patients referred and transported to the Children’s Hospital of Eastern Ontario (CHEO) for TH between October 2009 and December 2017, comparing the two cohorts of patients’ pre and post clinical practice changes (September 2015). 117 infants (mean gestational age 39.1 weeks, birth weight 3.3 kg, arterial cord pH 6.9, Apgar scores 3 and 5 at 5 and 10 minutes) were included: 82 infants pre-practice change and 35 infants post. Subsequent to the outlined practice changes in Table 1. data (pre vs post) demonstrated an increase in: the number of infants within target temperature range by 6 hours of life (49% to 68%), the number recommended for passive cooling at the referral centre (59% to 75%), of those passively cooled at the referral centre (9 to 16%) within target temperature range on arrival of the transport team. The time from birth to referral remains unchanged (median 95 vs. 92 mins). Targeted transport team practice changes have been successful in increasing the number of patients recommended for initiation of TH at referral centers and meeting the desired time target for TH within our region. The time from birth to patient referral remains a focus for further outreach education.
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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 | 0.016 | 0.029 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.006 |
| Scholarly communication | 0.007 | 0.006 |
| Open science | 0.001 | 0.003 |
| Research integrity | 0.002 | 0.004 |
| Insufficient payload (model declined to judge) | 0.006 | 0.002 |
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".