Effect of geographical distance on repeat pleural procedures in patients managed by indwelling pleural catheters: A retrospective cohort study
Bibliographic record
Abstract
INTRODUCTION Malignant pleural effusions are typically initially managed with thoracentesis or chest tubes prior to indwelling pleural catheter insertion. We sought to examine whether geographical distance from a specialized pleural effusion clinic affected the number of pleural procedures prior to the insertion of a definitive indwelling pleural catheter.METHODS This retrospective single-center cohort study included adult patients from Alberta with malignant pleural effusions who underwent indwelling catheter insertion at an outpatient pleural effusion clinic in Edmonton from November 1, 2012, to December 31, 2018. We collected data on demographic and indwelling pleural catheter characteristics. We computed a multivariable logistic analysis adjusting for age, sex, and malignancy type.RESULTS A total of 515 indwelling pleural catheters were inserted during the study period. Patients living in communities over 300 km away from the clinic were more likely to have undergone 3 or more pleural procedures prior to their indwelling pleural catheter insertion compared with patients living within 50 km of the clinic (OR 2.67; 95%CI 1.23 to 5.81; p = 0.0130). This association was also significant if their travel time was over 90 min when compared to 45 min or less (OR 1.98; 95%CI 1.10 to 3.56; p = 0.0232).CONCLUSION Patients residing in distant communities were more likely to have had multiple pleural procedures prior to the insertion of their indwelling pleural catheter for their malignant pleural effusion. This study highlights the impact of distance and limited access on how Canadians with refractory pleural effusions are treated.
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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 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 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".