A Qualitative Analysis of Barriers to Preoperative Aerobic Conditioning in the Thoracic Surgery Population
Bibliographic record
Abstract
Background: A giant hiatal hernia is defined as having greater than 50% of the stomach herniated into the chest. Giant hernias have an increased risk of gastric volvulus causing acute gastric obstruction and strangulation. Controversy exists regarding surgical intervention for asymptomatic giant hiatal hernias. The goals of this study are to determine the number of cases of giant hiatal hernias in a moderate sized Canadian city and to determine the number of cases of giant hiatal hernia referred for surgical assessment and/or needing emergent surgical intervention.Methods: The Capital Health District diagnostic imaging database, specifically CT, was searched for key words including hiatal hernia, diaphragmatic hernia, paraesophageal hernia, and intrathoracic stomach between Jan. 2010 u2013 Jan. 2015.Surgical interventions, emergency department encounters and surgical referrals were reviewed using personal health records. Results: A total of 357,213 CT chest/abdomen reports were searched yielding 388 patients reported to have a diaphragmatic hernia. Hiatal hernias were identified in185 patients (50.2%). Type III and IV hiatal hernias were reported in 75 patients (40%) including 30 (16.2%) giant hernias. Type IV hernias had the highest percentage of emergency department visits (36.4%). However, only 6 (20%) patients with type III and IV hernias were referred for surgical assessment. Seven (23%) patients with a giant hiatal hernia required emergent repair compare to no patient with a non-giant hernia (p <0.001). However, only 4 (57%) patients with a giant hiatal hernia requiring emergent surgery were referred for elective surgical assessment. Conclusion: Congenital and type I hiatal hernias compromise the majority of diaphragmatic hernias. Emergency department encounters and need for emergent surgical intervention were highest among Type III and IV hiatal hernias. Patients with giant hiatal hernia are at increased risk for needing emergent surgery. Patients with Type III and IV hernias, and especially those with a giant hiatal hernia, should be referred for surgical assessment because of an increased risk of needing emergent surgical intervention.
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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 | 0.004 | 0.014 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.003 | 0.002 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.003 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 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".