Bibliographic record
Abstract
Antihypertensives are prevalent in long-term care (LTC) populations, however the ratio of benefit to harm of antihypertensive treatment is unclear. There has not yet been a randomized controlled trial to examine the impact of deprescribing all classes of antihypertensive medication in the frail older adult population with a primary outcome of mortality. This thesis is focused on designing a study protocol to address this. This thesis has two parts: (1) a scoping review of cluster randomized trials in LTC and (2) a protocol for a randomized controlled antihypertensive deprescribing trial in LTC. Study 1. The scoping review was done to help plan the randomized controlled trial. It followed PRISMA guidelines. Studies were included if the design was cluster randomized and residents were from LTC facilities. 195 studies met the inclusion criteria; they were published between 1976 and 2017, with 53% of studies published after 2009. Six percent of studies (n=14) had an Intervention target related to medications, and none of these were on antihypertensive medication. In addition the majority of studies did obtain consent from residents and/or their proxy. Study 2. The protocol is for a randomized, two parallel group, open-label, event driven trial. It will include 515 LTC residents with a diagnosis of hypertension, on ≥ one antihypertensive medication, and a systolic blood pressure ≤135 mmHg, and follow them for 3 years. The data steward, Alberta Health Services’ Research Data Services, will identify and randomize residents, and analyze the results. The facility pharmacist will deprescribe antihypertensives in the intervention group using the algorithm developed by the study authors. The primary outcome is time to all-cause mortality, and secondary outcomes include safety, qualify of life and process measures. In conclusion, the study designed will help provide clarity to the question of antihypertensive deprescribing in LTC. It is anticipated the results will guide practitioners, and be used in setting hypertension guidelines for the frail older adult population.
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 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 | 0.031 | 0.075 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.004 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.002 | 0.003 |
| Insufficient payload (model declined to judge) | 0.007 | 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".