Bibliographic record
Abstract
INTRODUCTION AND OBJECTIVES: The management of kidney stone disease has changed dramatically over the past 30 years. In particular, ureteroscopy (URS) has become a more efficacious procedure with less morbidity. As a result, based on physician surveys and reports from single centre series the rate of URS appears to have increased over time. However, large population-based evaluations to assess the changes over time in the surgical treatment of kidney stone disease have not been conducted. Our objective was to evaluate population-based trends in the use of extracorporeal shockwave lithotripsy (SWL), URS and percutaneous nephrolithotomy (PCNL) over the past 20 years, in Ontario. METHODS: Using the Ontario Health Insurance Plan physician claims database we conducted a population-based cross-section time series analysis by identifying all kidney stone treatments performed between July 1, 1991 and Dec. 31, 2010, in the province of Ontario. The primary endpoint was the proportion of all stone treatments represented by each modality, which was calculated for every 3-month block over the study period. Exponential smoothing models were utilized to assess for trends over time in the percent utilization of each of SWL, URS and PCNL. RESULTS: We identified 194,781 kidney stone treatments between July 1, 1991 and Dec. 31, 2010. A total of 96,807 SWL treatments, 83,923 URS treatments and 14,051 PCNL treatments were performed. We observed a significant trend over time for decreased utilization of SWL (68.5% to 33.7%, p<0.0001) and an increase in URS utilization (24.6% to 59.5%, p=0.0002), while no change over time was found for PCNL (6.88% to 6.85%, p=0.97) (Fig. 1). By the end of 2004, URS had become the most widely used procedure. CONCLUSIONS: Our population-based study confirms the increased use of URS over time suggested by physician survey and single centre retrospective series. Accordingly, the utilization of SWL has decreased in a reciprocal fashion.
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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 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.003 | 0.003 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.005 | 0.002 |
| Open science | 0.002 | 0.003 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.831 | 0.697 |
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".