Bibliographic record
Abstract
Dr. Zohar et al. (1), compared the blood-sparing effects of tranexamic acid (TA) and acute normovolemic hemodilution (ANH) in patients undergoing total knee replacement (TKR). There are at least two reasons why this comparison is inappropriate. First, as the authors state, TKR is performed with an occlusive tourniquet and is associated with minimal intraoperative but extensive postoperative blood loss. For this very reason, ANH as performed in this study (i.e., re-infusion of blood on arrival in the postanesthesia care unit) is not expected to be very beneficial for TKR and is therefore not recommended (2). Second, the study design was such that the ANH group was put at an increased risk of receiving blood. There are two reasons for this: the preoperative hematocrit was smaller in the ANH group (even if it was not statistically significant), and more importantly, patients in the ANH group were much more likely to reach the transfusion trigger of 27% as a result of hemodilution (they received 22 mL/kg more fluid and had urine outputs similar to the TA group). This increased risk of transfusion is evident by the extremely frequent transfusion rate in the ANH group (65% vs 5% in the TA group), despite only a modest difference in postoperative blood loss between the two groups. In fact, the expected transfusion rate for this procedure in patients lacking autologous blood is less than 30% (3). At our institution, the current transfusion rate is less than 15%. The role of TA in TKR can only be assessed by randomized, placebo-controlled clinical trials. Few such studies have been published to date (4–6). Because TA is an expensive treatment modality with potentially serious adverse effects, further trials are required before its use can be recommended. Furthermore, because TA is not yet considered to be standard-practice for TKR, I do not agree with the authors’ statement that such trials are now ethically unacceptable. Keyvan Karkouti MD, FRCPC, MSc
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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 | 0.001 | 0.007 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
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".