Prebiologic Evaluation: Follow-up Survey of Practice Patterns in Nova Scotia
Bibliographic record
Abstract
Introduction: There has been a significant increase in the use of biologic therapy across Canada. Given the risks associated with this therapy, appropriate pre-treatment evaluation is important. This study reports the impact a pre-biologic therapy initiation checklist that was distributed across Nova Scotia with the goal of enhancing and streamlining care for patients receiving TNF-alpha inhibitor therapy. Changes in practice were examined using pre- and post-checklist distribution surveys. Methods: A pre-checklist survey was carried out in July 2012. The checklist was then distributed in February 2013 with a post-checklist survey conducted in July 2014. A total 63 specialists were provided with the checklist and invited to participate in the surveys. Results: Of the 63 surveys distributed, 35 (55.5%) were returned in both the pre- and post-surveys. The number of responding specialists was different with dermatology (8 vs. 6), rheumatology (9 vs. 5), and gastroenterology (18 vs. 24). In the post-survey the percentage reporting evaluation of risk activity/symptoms was high [HIV (88%), chronic infection (97%), herpes simplex (62%), perianal sepsis (69%) and cervical dysplasia in women (52%)]. The reported testing was also high [CBC (100%), LFT (97%), TB Skin Test (100%), CXR (89%), creatinine (89%), CRP (94%), and HBV (94%)]. Less frequent testing included ESR (63%), HIV (65%), varicella antibodies (64%), and urinalysis (21%). Vaccinations that were considered important included HPV (30%), HBV (61%), Tetanus (41%), Rubella (47%), Pneumococcal (71%) and Seasonal Influenza (73%). Specialists were less likely to provide vaccinations (37%) and most referred the patients to their primary care physician (97%). Routine warnings to patients were universal for infection (100%), but less for allergic/infusion reactions (71%) and cancer (63%). Figure 1 shows that several practices increased between the pre and post survey. These included HIV serology (p=0.017), Hepatitis B serology (p=0.021), arranging vaccinations (p=0.044), and referral to family physician for vaccinations (p=0.033). Varicella zoster serology was found to have decreased (p=0.016). Many of the other activities increased but not significantly.Figure 1Conclusion: The ‘Biologic Checklist' appears to increase the pre-treatment evaluation and vaccination rate in patients receiving biologic therapy.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot 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.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 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 teacher head, 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".