Optimizing Care for Pregnancy in Rheumatic Diseases: Barriers and Potential Solutions
Bibliographic record
Abstract
With improved disease control, an increasing number of women with rheumatic diseases (RDs) are considering pregnancies. Though there are many international guidelines available for managing pregnancies in RD, the execution of a plan for such care is generally limited by several factors, leaving gaps between evidence and practice.1-4 In this issue of The Journal of Rheumatology , a multicenter survey by Tani et al on patient care pathways in pregnant women with rare and complex connective tissue disease is an important step in attempting to map existing care pathways.5 Data were collected from 69 centers across 21 countries. Ninety-one percent of centers provided services to pregnant women with RD by a multidisciplinary team (MDT) that included gynecologists/obstetricians (though formalized inclusion of other disciplines was present only in 30% of centers). Pre-pregnancy care was provided in a majority (96%) of these centers, and in 64%, this care was provided by community-based general practitioners. However, a formalized care pathway for these pregnant women was established only in 49% of centers, and there was lack of adequate use of appropriate checklists or predefined protocols during the pregnancy (20%) and postpartum (19%) phases. Likewise, the frequency of monitoring during the pregnancy and postpartum phases was also variable between centers. Heterogeneity between these centers was further evident in their ability to prescribe drugs compatible with pregnancy. Notwithstanding a lack of generalizability arising mainly out of the involvement of far more centers based in Europe (54 out of 69 centers, with 27 from Italy) and a sampling bias due to survey respondents mostly being specialists in reproductive rheumatology, the present study does hold up a mirror in front of us with regard to providing optimum care for pregnancy in RDs.5 Clinical care … Address correspondence to Dr. V. Ravindran, Centre for Rheumatology, Calicut 673009, Kerala, India. Email: drvinod12{at}gmail.com.
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 | 0.024 | 0.062 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.005 | 0.003 |
| Scholarly communication | 0.008 | 0.007 |
| Open science | 0.004 | 0.011 |
| Research integrity | 0.005 | 0.008 |
| Insufficient payload (model declined to judge) | 0.006 | 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".