Select Practice Challenges for 2024
Bibliographic record
Abstract
Facing a new year, the contributions of our authors reflect their current practice preoccupations. There is no doubt that for our physicians, the top of their list is the management of the opioid epidemic. This issue includes several attempts at answering these questions confronting our colleagues. Bakouni et al compare the effectiveness of buprenorphine/naloxone (BUP/NX) versus methadone for withdrawal symptoms using data from OPTIMA, a pan-Canadian randomized controlled trial. Methadone is associated with decreased withdrawal symptoms earlier during treatment compared to BUP/NX, particularly in cases involving fentanyl. Just like opioid overdoses often occur with combined opioids, Srivastava and Kahan report on the possible benefit of combining slow-release oral morphine with methadone maintenance treatment for long-term opioid agonist maintenance. Newborns exposed to opioids in utero experience withdrawal syndrome traditionally managed in a neonatal intensive care unit (NICU) for continuous cardio-respiratory monitoring. Patricelli et al, in a 5-year retrospective chart review at the BC Women’s Hospital, report that with the administration of a morphine oral solution, the monitoring in NICU may not be necessary, promoting instead a cost-effective rooming-in model of care. Digital health resources for substance use to support females according to gender and trauma-informed care principles are rated for conformity by Quilty et al. The rating process for 23 such digital resources available in Canada elicits that these resources identify some features of trauma-informed care and few features of gender-informed care. More features of social determinants to be included in these digital resources are recommended. A major recent public health initiative has been the promotion of the administration of naloxone by peers. From a literature review, Dlugos et al analyze 27 studies reporting on promising evidence for this strategy to reduce the risk of opioid overdoses. More prospective and controlled studies are warranted. This set of opioid-related articles has the common goal of expanding the range and specificity of opioid management options available to our practitioners. In the last article, addressing smoking as another major public health concern, Dahal et al report on data from a Canadian health survey, including a sample of 640 women who smoked regularly within 3 months before knowing of the pregnancy. The outcome variables are dichotomized as cessation or continuation of smoking during pregnancy, along with the availability of the regular care of a family physician. Overall, 26.5% of regular smokers before pregnancy quit smoking during pregnancy. This proportion was lower in the presence of second-hand smoke (14.3%) and higher in the presence of a regular family physician (29.9%). We hope that these articles facilitate decision-making during the course of our practices. Nady el-Guebaly CM, MD, FRCPC Editor-in-Chief, CJA
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| 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 teacher head, 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".