Use of Immunomodulators and Anti-TNF Agents in Patients Admitted with an Exacerbation of Crohnʼs Disease in St. Johnʼs
Bibliographic record
Abstract
Purpose: The purpose of this study is to characterize the clinical management, specifically the use of immunomodulators and anti-TNF agents, of patients admitted with an exacerbation of crohn's disease. Methods: A retrospective cohort study was conducted. Cases were gathered and examined by an admission diagnosis of Crohn's exacerbation in St. John's, Canada, in 2011. Medical therapy, including 5-ASAs, immunomodulators, and anti-TNF agents, administered prior to admission was recorded. The addition of these agents during an admission and subsequently after discharge was also recorded. Results: There were 57 cases (inpatients) identified to be primarily attributable to Crohn's disease in 2011 at the two hospitals in St. John's. On admission 45.6% of patients were on no maintenance therapy, 22.8% were receiving 5-ASAs, 22.8% were on immunomodulators, and 19.3% were on anti-TNF agents. Upon discharge 21.1 % were taking 5-ASAs, 31.6% on immunomodulators, and 15.8% on anti-TNF agents. Since discharge 26.3% are currently on 5-ASAs, 43.9% on immunmodulators, and 31.6% on anti-TNF agents. Conclusion: Crohn's disease is a multisystem inflammatory disorder and there are current guidelines in place for its management. In the 57 patients who were admitted to hospital in St. John's in 2011 with a diagnosis of a crohn's exacerabation, management prior to admission, during admission and post discharge was examined. Of the 57 admissions, 42.1% were on immunomodulator or anti-TNF therapy prior to admission, and subsequently since discharge that number has increased to 75.5%. It appears that overall, the medical therapy was escalated in a step-up approach appropriately. The escalation of therapy could be an indication that some of these patients were undertreated prior to admission and may have required more aggressive therapy initially to prevent admissions.
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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 | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 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".